LIBRARY OF CONGRESS. 



Shelf. -_iii&& 



UNITED STATES OF AMERICA. 



YELLOW FEVER 



ITS SHIP ORIGIN 



AND 



PREVENTION. 



f *> 



r 



BY ROBERT B. S. HARGIS, M. D. 



PENSACOLA, FLORIDA. 




D. G. BRINTON, M. D., Publisher, 

115 SOUTH SEVENTH STREET, 
PHILADELPHIA. 



Q> 



CONTENTS. 



Introduction 3 

The Ship Origin of Yellow Fever 9 

Practical Hints Relating to Yellow Fever 42 

The Most Recent Utterances -on Acclimatization and 

Endemicity 54 

The Origin op the Poison op Yellow Fever 65 

Letter by Prop. John Gamgee to the Author 66 

Letter by Prop. John Gamgee to Rear-Admiral Daniel 
Ammen on the Inter-Oceanic Canal and Yellow Fever 

Zone 68 

INDEX , , 77 



Entered, according to the Act of Congress, in the year 1880, 

By ROBERT B. S. HARGIS, M. D., 

In the office of the Librarian of Congress, at Washington. 



INTRODUCTION. 



The dangerous and irrational proceedings, constantly ad- 
vocated, in relation to the prevention of yellow fever, induce 
me to reprint three articles, which have recently appeared in 
medical journals, and which, if I may judge from kind let- 
ters received, have met with approval on the part of many 
of my professional brethren. Twenty-two years have so 
familiarized me with the idea, based on many facts, of the 
naval genesis of this disease, that I am much in the posi- 
tion of all who acquire positive knowledge on any question, 
and who become intolerant of error. A man who insists 
to-day that the earth is flat is simply regarded as an idiot, 
whereas Columbus, when leading that immortal expedition 
which was the forerunner of our new world life, and of all 
yellow fever epidemics, had great difficulty in convincing 
his adversaries and followers that he was not going to the 
edge of the earth's broad plane, thence to drop into un- 
fathomable space. 

I plead guilty to a charge which may be made against 
many who acquire firm convictions, viz., that I did not 
take time — which, in truth, I could ill afford — to publish in 
book form, such evidence as had converted me from being 
a believer in the land origin of the disease. Evidence of 
this character was brought together, last year, by Professor 
John Gamgee in his work on " Yellow Fever a Kautical 
Disease," which was in the press when my views were first 
made known to him. A careful study of the question en- 
abled him to define the geographical limits of the disease, 
its probable origin in the calm belts, the exemption of all 
other seas except the tropical Atlantic, and that it never 



Introduction. 



had penetrated continents, but had confined its ravages to 
seaports and places in direct communication with seaports. 
He was as impatient, as I was, at the insinuations that yel- 
low fever was a disease of the American continent, as ex- 
pressed by a German author, and failed to conceive how 
any one could imagine that it developed spontaneously in 
New Orleans or any of the Antilles. 

From the publication of my first paper, in the New Or- 
leans Medical News and Hospital Gazette, in 1858, occasional 
newspaper articles and discussions had led some physic- 
ians to understand my views ; but the necessity for wide 
and repeated statement of the simplest truth is indicated 
by that admirably edited work, Parkes' Practical Hygi- 
ene. Both Professor Parkes and Doctor De Chaumont. 
who are responsible for this work, have long been con- 
nected with an army medical school ; and it is matter 
of history how seriously the British soldiers and sail- 
ors have, until within recent years, been afflicted with yel- 
low fever in the West Indies. Turning to the chapter 
on the prevention of some important and common dis- 
eases, we find that " the question of the origin of yellow 
fever is one which cannot be considered in this volume, 
and at present no preventive rules of importance can be 
drawn from the discussion." 

Is it possible to acknowledge impotence in stronger lan- 
guage, when a studious review, of the cause and develop- 
ment of jrellow fever, could scarcely lead to any other con- 
clusion, than that which Copland found himself conquered 
by, viz., that, after all, no opinion could be sustained with 
more irrefragable evidence than that yellow fever originated 
in foul ships ? 

To those who know what the inhalation of nitrous acid 
fumes implies, and who have experience of the slender 
touch that kicks the beam, in the balance between life and 
death, in yellow fever, the following sentence must sound 



Introduction. 



absolutely inexplicable : u In all buildings where sick are, or 
where yellow fever prevails, there should be constant fumi- 
gation with nitrous acid, which seems to be, as far as we 
know, the best disinfectant for this disease." 

The only possible and sufficient purifier is an unlimited 
supply of wholesome air, and when adequate ventilation, 
without the poisonous contamination of adjoining rooms, 
houses, or streets, may be secured, the irritating, killing, and 
worse than useless, vapors, so abundantly prescribed, will 
fall into disuse. Bearing on the influence of pure or 
impure air as the cause of yellow fever, I desire to quote the 
words ofan excellent observer, for whom I entertain a great 
respect, and who was commissioned, in consequence of a sug- 
gestion of mine, to investigate yellow fever. In the second vol- 
ume of the public health reports and papers, published by the 
American Public Health Association, Dr. Harvey E. Brown, 
Surgeon United States Army, has a paper on Yellow Fever 
in the Dry Tortugas. In concluding it he says : 

" I desire to offer a few remarks concerning the question 
of the transfer or isolation of population from infected lo- 
calities. This, to be sure, is no longer an open question. 
Its advisability has been proved in so many instances, that 
it is only on the ground of accumulating testimony on its 
advantage that it is worth while to mention it. 

' ; It is a curious fact in the history of yellow fever (and, 
perhaps, of other infectious diseases) that a community al- 
ready infected may be moved from the locality where the 
disease first appeared ; and that in its new and healthy lo- 
cation, no new cases will occur, except among those who were 
passing through the period of incubation at the time of such 
removal. In July, 1867, yellow fever was carried by a sick 
man from the town of Indianola, Texas, to the permanent 
military camp, distant a mile from town. Twenty-two 
cases and twelve deaths occurred, after which the command 
was moved to Green Lake, a healthy country locality some 



6 Introduction. 



twenty miles distant. But two cases occurred after the 
removal, the remainder of the command keeping perfectly 
well, while a few soldiers, who had been left behind at the 
old post, all had the disease. 

" In the epidemic of 1873, at Fort Jefferson, the troops 
were removed to Loggerhead, Ky., on the 28th August, a 
week after the disease had become epidemic. After re- 
moval, one man was taken at Loggerhead on the 29th, one 
on the 31st, and two on the 2d of September, all of whom 
were promptly returned to the post, after which the disease 
ceased at Loggerhead, and the command remained perfectly 
healthy. When the troops moved, several men remained 
behind at the fort ; all but one of these took the disease, 
and that one was the ordnance sergeant, who lived in a 
distant part of the work, and held no communication with 
the other parts of the fort. 

" The removal of the sick to a distance, leaving those 
who have not been attacked behind, was shown to be of no 
value in the epidemic of 1870, on Governor's Island, New 
York harbor — cases of the disease continuing to occur for a 
month after the sick had been so removed. This absence 
of disposition to spread (as we may call it) has always been 
used as a strong point in favor of the non-infectious nature 
of the disease, but a little consideration will show the fal- 
lacious character of the argument. The conditions in the 
two localities are entirely different. When the fever breaks 
out among troops or permanent barracks, its generating prin- 
ciple quickly infects the walls, wood work, and furniture 
of the quarters. Moreover, within the walls of a fort or in 
barracks, there is always a certain amount of residual air, 
which the ordinary wind-currents are not sufficient to en- 
tirely remove. This speedily becomes charged with the 
poison, and thus resembles that contained in the infected hold 
of a ship, producing the disease in all susceptible persons who 
respire it. Let, however, the population of such an infect" 



Introduction. 



ed locality be removed into tents in an open country, and 
all these deleterious conditions disappear. The tents should 
be so arranged as to afford a frequent and complete renewal 
of the atmosphere ; if they become infected, they and their 
contents should be immediately destroyed. 

" We may lay it down as an established fact that the 
cessation of yellow fever, and its inability to spread after re- 
moval of the well people from a locality where it exists, so 
far from its being any argument against its infectiousness, is 
really one in favor of it, for this reason : where the sick are 
moved instead of the well, as at Governor's Island, in 1870, 
the epidemic continues, all the conditions for its propaga- 
tion being still present." 

Would that observers had always been as precise and 
reporters as logical as Dr. Harvey E. Brown. We should 
then not have to criticize the excellent compilations which 
are mixing "chaff with the wheat" offered to medical 
students and sanitary officers. Can anything be more pre- 
posterous than the plan adopted in the British Navy, en- 
dorsed by Parkes, who says, "as a matter of precaution, the 
present plan of three or five years' Mediterranean service 
before passing to the West Indies seems desirable." 

In his New Orleans lectures, Mr. Gamgee showed that the 
enclosed seas, though the hottest, such as the Mediterranean 
and the Red sea, have always been exempt from yellow 
fever. It only penetrated, by importation, to Minorca, 
Leghorn, Malta and Egypt early this century, carried by 
contaminated vessels, infected directly or indirectly in the 
West Indian Archipelago. It is this scrutiny of history 
which arms us with facts, such as no authority has been 
able to adduce in relation to the spontaneous origin of the 
yellow fever on land. Mr. Gamgee has ransacked every 
source of information, as I have done for over a quarter of 
a century, and, apart the interesting manifestations of Oroya 
Fever in the Andes, nothing which could in any way be 



8 Introduction. 

confounded with Yellow Fever has been traced to specific 
land influences. History, accurate knowledge of genuine 
endemics, the geographical distribution of disease and the 
overwhelming evidence of outbreaks of yellow fever in 
ships without contact with infected lands, may be relied on 
to confront and confound the " opinions" of those Port Phy- 
sicians who indulge in catastrophic etiology. Noah Web- 
ster — a great man, but a bad pathologist — is really their 
luminary, and no one since his day has equalled him in 
marshalling all facts, but those right ones, on which, justly 
interpreted, now is woven an indelible generalization — that 
Yellow Fever is the Ship Fever of the Tropical Atlantic. 



THE SHIP ORIGIN OF YELLOW FEVER. 



X 



America may well be proud of the attitude assumed, and 
successfully maintained, by its medical men, on the great 
question of Public Hygiene. State Boards of Health, the 
American Public Health Association, and last, but not least, 
the National Board of Health, represent the vigorous ef- 
forts of practical Sanitarians for the permanent advance- 
ment of the country's welfare. A boon beyond all price 
to the New World is to result from efforts aimed mainly 
at the prevention of Yellow Fever. Whatever conflicts 
of opinioD or errors in practice may retard the work, I am 
confident, as I said years since, that under an adequate cen- 
tral administration by a Medical Board, the plague of 
American commerce, more especially of Atlantic sea ports, 
can be stayed and extinguished for all future time from the 
bloody annals of controllable epidemics. 

One year's experience of the operations of the National 
Board of Health satisfies me that the disease is being at- 
tacked locally on land as a contagion, whatever the precise 
method of transmission may be, and that special centres 
for the isolation and purification of shipping are to liberate 
commerce of unnecessary inter-State obstructions. The 
practical difficulties encountered will suggest the details of 
a preventive system. The land will be cleared of the mal- 
ady and its threatened invasion in shipping will be met ra- 
tionally. If I know anything in medicine — if there be 
any medical truth which I have grasped by searching meth- 
ods of careful study — it is that, year by year, a fresh crop 

^Reprinted from G-aillard's Medical Journal for June, 1880. 



10 The Ship Origin of Yellow Fever. 

of poison springs from foul vessels sailing in the tropical 
Atlantic, and from such infected ships, or their contents, 
and others infected directly or indirectly by them, the 
country can be protected without onerous restrictions on 
commerce. 

As physicians we must never forget that prosperity is 
the surest key to national vigor and individual health. Ob- 
noxious quarantines and schemes of non-intercourse imply 
an acknowledgement of our impotence. Happily we are 
far from being driven to this extremity. The meaningless 
term, quarantine, should be made obsolete. It is odious 
to all and its use excites more enmity than the most tedious 
safeguards we have to impose. Professor John Gamgee, 
whose work on "Yellow Fever, a Nautical Disease," should 
be studied by every medical man, has suggested to me the 
expression "Sanitation," instead of "Quarantine Station." 
The word sanistation refers to the practical preventive or 
purifying measure to be applied on land or ships. Why 
not speak of "Ship Island Sanistation" instead of "Ship Is- 
land Quarantine"? 

An unexpected incident has induced me to direct the 
attention of my professional brethren to a correspondence 
which has appeared in the Pensacola and other papers. 
In reply to a circular issued by Dr. J. C. LeHardy, of Sa- 
vannah, relating to proposed Congressional action affecting 
the National Board of Health, whilst strongly advocating 
that the powers of the Board should be increased rather 
than curtailed, I remarked as follows : 

" The National Board of Health has been unfortunate in 
favoring the view that Yellow Fever is endemic in Cuba. 
The report of the Havana Commission must, before another 
decade is past, meet, as it deserves, with the strongest con- 
demnation. Such is my opinion on this point. It is diffi- 
cult enough to get the Spanish Government to do its duty, 
towards this country, by purifying the Pearl of the Antilles, 



The Ship Origin of Yellow Fever. 11 

and how can we hope for their energetic action when an 
American Physician, clothed with all the prestige of au- 
thority, assures the world that Yellow Fever in Havana is 
inevitable ? 

" In this most healthy region, (Pensacola, Ma.,) singularly 
free from contagious maladies, where climatic seasonal con- 
ditions only rarely favor the propagation of imported yellow 
fever, and where the winter hibernation of the malady has 
been proved impossible over a period, to my knowledge, of 
30 years, how can we throw open our Port to commerce, in 
summer and autumn, when a single ship from Cuba having 
one case of the disease on board, will close all inland com- 
munication ? 

" It is, I confess, with absolute impatience that I learn of 
the continued advocacy of the local origin of yellow fever, 
either on this Continent or in the West Indian Islands. 
The blunders of the Profession are still in striking contrast 
to the common sense of the people, on the one vital ques- 
tion of the communicability of this disease. The eloquent 
teachings of shot-guns quarantine — detestable as every form 
of real or apparant inhumanity must be — may yet drive 
home the substantial truths, in relation to the transmissi- 
bility of the malady by Eailroads and Kefugees." 

This provoked an answer from Dr. Chaille, which tends 
to remove any doubt as to the tendency of the Report, 
which so far as I am aware has not been discussed in the 
Medical Journals. That such discussion is urgently called 
for, I trust to prove by comments intended to avert mis- 
chief if they fail to elicit truth. 

New Orleans, March 19, 1880. 
Editor of the Pensacola Advance : 

Dear Sir : My attention has been called, this day, to the letter of 
Dr. Hargis on yellow fever, published in your issue of March 10, 1880, 
and I respectfully submit that in opening your colurns to a denuncia- 
tory attack, common j ustice requires that equal publicity should be 
given to the defence. 



12 The Ship Origin of Yellow Fever. 

Dr. Hargis, whom I know, and have had reason to regard Math 
friendship and respect, states: "The National Board of Health has 
been unfortunate in favoring the view that yellow fever is endemic in 
Cuba. The report of the Havana commission must, before another dec- 
ade, meet, as it deserves, the 'strongest condemnation. Such is my 
opinion on this point. " 

Dr. Hargis would confer a favor by stating when and where the 
National Board of Health "unfortunately favored" any such view. 
This board did instruct its Havana committee to investigate "the so- 
called endemicity of yellow fever in Cuba." I am not aware that it 
has ever said or done more than this to unfortunately favor a view, in 
opposition to which Dr. Hargis will find it difficult to cite one single 
Cuban authority, of any weight in medicine. In Cuba yellow fever is 
very certainly a "so-called endemic." 

While this is the non-committal position of the National Board of 
Health, the Havana yellow fever commission calls attention to the in- 
definiteness of the signification of the word " endemic," and then states 
that if the word is accepted as signifying an habitual annual prevalence 
of a disease, and the existence of causes favoring its propagation, then 
the facts prove that yellow fever is endemic in certain localities in Cuba. 
The facts, on which this conclusion is based, are stated, so that no man 
can be led astray either by the indefiniteness of the word endemic, or 
by the theories and fancies of the commission, which, under the cir- 
cumstances, will await with great equanimity the expiration of Dr. 
Hargis' fatal decade. So much for "this one point." 

Dr. H. also writes: "It is difficult enough to get the Spanish Gov- 
ernment to do its duty towards this country by purifying the Pearl of 
the Antilles, and how can we hope for this energetic action when an 
American physician, clothed with all the prestige of authority, assures 
the world that yellow fever in Havana is inevitable?" I, Mr. Editor, 
am this unfortunate unrepentant " American physician." Here, again, 
as everywhere, the facts were first given, in order that "the world" 
might correctly judge the validity of the conclusion. Those facts are, 
briefly, that since 1761 yellow fever has annually prevailed in Havana; 
that all the favoring conditions during the past one hundred and 
twenty-eight years persist; that there were no evidence that these con- 
ditions would be arrested, and that as long as these conditions persisted 
it was inevitable that the effect would persist. The Havana commis- 
sion is well assured of the correctness" of the premises of this syllo- 
gism, and submits the conclusion with great confidence to the test of logic. 

In fine it seems that Dr. Hargis is an earnest advocate for the origin 
of yellow fever on ships — a view which the Havana yellow fever com- 
mission earnestly condemns, and here, I imagine, is the great cause 



The Ship Origin of Yellow Fever. 13 

of his offence against, and condemnation of, the commission. But the 
commission was careful to state the facts on which its opinion was 
founded, and feels very confident that however false this may be, all 
just and generous men will view with liberal charity any such con- 
clusion when preceded by and accompanied with the very facts from 
which it was deduced. 

In conclusion, Mr. Editor, permit me to make a prophecy about 
that "next decade " with which Dr. Hargisso unmercifully threatens 
the Havana yellow fever commission. This prophecy is, that at its 
expiration many more doctors than at present (though they are nu- 
merous) will think it as idle a waste of words to discuss the origin of 
yellow fever as to discuss the origin of a cat or of a dog. The great 
practical question is with yellow fever (as with all vegetables, ani- 
mals, and epidemic diseases), how is it propagated? For rny own 
part, I have even less hope of determining the origin of yellow fever 
than the origin of small -pox, scarlatina, typhoid fever, cholera, trichina, 
tape worm, etc. Now, if Dr. Hargis will inform us how the causes 
of any of these originate, while handling with so much confidence the 
origin of yellow fever, he will confer an inestimable favor on science 
and mankind. In order that the correctness of my statements may be 
tested, I forward you a copy of the report of the Havana yellow fever 
commission. Yours, very truly, 

STAFFORD E. CHAILLE, M. D., 
President of Havana Yellow Fever Commission 

of the U. 8. National Board of Health. 

To which I replied as follows : 

Editor Pensacola Advance : 

Sir: Grateful am I for the publication this day of my friend Dr. 
Chaille's remarks on my letter which appeared on the 10th inst. I 
have known Dr. Chaille for many years. It is the privilege and duty 
of professional men to discuss scientific questions, with ardor and 
force, based on intelligent conviction, whilst avoiding personalities. 
You, sir, have enabled Dr. Chaille to define his position, and to stand 
in self-defense in the most manly attitude, not sheltered behind the 
titles of the Havana Commission and the National Board of Health. I 
accept his challenge only for truth's victory and the demolition of 
specious argument or theory based on false premises. 

Dr. Chaille holds himself responsible for "a concise preliminary re- 
port, stating the general results accomplished " by the Havana com- 
mission, so far, at all events, as the question in dispute, and which 
refer to the endemicity of yellow fever in Cuba and the origin of the 
disease in ships and harbors. 



14 The Ship Origin of Yellow Fever. 

Whatever mystery there might have been as to his interpretation of 
the word endemic it is dispelled. It is used by the Havana yellow 
fever commission to signify the "habitual prevalence of a disease and 
the existence of causes favoring its propagation." The "facts are, 
briefly, that since 1761 the yellow fever has annually prevailed in 
Havana; that all the favoring conditions during the past one hundred 
and twenty-eight years persist; that there were no evidences that 
these conditions would be arrested, and that as long as these conditions 
persisted it was inevitable that the effects would persist." 

Words in diplomacy may be used to conceal man's thoughts; the 
language of science should be precise. Webster, after Hoblyn, de- 
fines endemial or endemic as signifying "peculiar to a people or a na- 
tion, and endemization as equivalent to naturalization, to indicate an 
indigenous growth. We speak of ague as an endemic of the marshes. 
It is an autocthonous disease springing from the soil — from local con- 
ditions. Cholera is the endemic of Hindostan, and only known to us 
in America like yellow fever, as an imported plague, pestilence, or 
epidemic; and, at most, medical men have spoken of sporadic cases, 
to indicate isolated attacks, before or after epidemics, or as casual ac- 
cidents. When the Havana commission, in its report, speaks of small- 
pox as endemic in Havana, it confounds yellow fever with the purely 
contagious maladies, and classes it where it cannot for one moment 
be placed by an enlightened pathologist. That Dr. Chaille commits 
this serious error is shown by the important conclusion, that "it is as 
idle a waste of words to discuss the origin of yellow fever as to discuss 
the origin of a cat or dog" — "for my own part," he adds: "I have 
even less hope of determining the origin of yellow fever than the 
origin of small -pox, scarlatina, typhoid fever, trichina, tapeworm, etc." 
The fact, sir, that yellow fever is totally unlike any of these diseases, 
that it is entirely specific and distinct, and, unlike any other known 
plague, invades land rather than springing and spreading from land, 
stamps it with peculiarities which enable us to determine its origin. 
There is no more interesting truth in pathology, nor one better estab- 
lished to those who are not blind or deaf to the clearest evidence, that 
the yellow fever poison, engendered and reproduced outside the hu- 
man system, is the active cause of an infection and malignant pesti- 
lence which may travel under favorable conditions wherever man 
may go, even as far north as Quebec. The correct history of yellow 
fever places it indisputably amongst the localized diseases of the globe, 
and its habitat since the discovery of the new world, and not before, 
has been the tropical Atlantic. It has not originated in the Pacific, 
nor in the Indian Ocean; in the Mediterranean, nor in the Red Sea. 
But within the tropical Atlantic belt the records of all islands and 



The Ship Origin of Yellow Fever. 15 

cities, including Havana, is the record of every American city such as ' 
New Orleans and Pensacola. 

Since, therefore, yellow fever has unquestionably its centre of de- 
velopment on ships in the tropical Atlantic, and is transmissible 
from the ship to the port and from the port back to the ship again, 
many intelligent and trustworthy observers, without prejudice and 
sophistry, have recorded the spontaneous development of the disease 
on the broad ocean. If the vast array of facts, carefully studied, indi- 
cate this to be possible and frequent, the acknowledged impossibility 
of tracing its land origin anywhere, indicates that I am fully justified 
in considering the disease in its inception as a. ship fever. 

Dr. Chaille did not hesitate in his concise report to devote ample 
space to the denunciation of this view and of those who entertained it. 
He said "there were formerly many, and there are still some few, 
who, without personal experience or extensive knowledge of the spec- 
ial subject, look upon it in a much simpler light. They pronounce 
yellow fever a "nautical disease." Until the publication last October 
of Prof. Gamgee's work, entitled " Yellow Fever, a Nautical Disease," 
I was practically the only person who had since 1858 adopted and 
propagated the idea that yellow fever was a disease of ships at sea; 
and since 1839 I have been an active observer of six great epidemics 
in Mobile, New Orleans, Pensacola and Milton, besides an annual ex- 
perience with many sporadic cases amongst the shipping in this bay 
and the United States marine hospital. 

But Dr. Chaille thinks naval surgeons best entitled to credence, and 
quotes Dutroulau, who was compelled to publish in 1851 that in not 
a single instance of many infected vessels did the disease "originate 
onboard." This is a sample of the authorities and facts given "in 
order that the world might correctly judge the validity of the conclu- 
sions," and the Havana commission submits this "with great confi- 
dence to the test of logic." 

There are not many physicians in this country who have access to 
French medical libraries, and Dr. Chaille has not sought the refer- 
ences, numerous enough in the English language. His champion is 
Dutroulau, whose recorded facts and main conclusions Dr. Chaille 
passes over in profound silence, with the object, I suppose, to use his 
own words, that "all just and generous men will view with liberal 
charity any such conclusions when preceded by and accompanied 
with ' ' his own selection of data. ' ' I have not read Dutroulau' s works, 
but I have before me the very able lecture delivered by Prof. Gamgee 
on the 16th of December, in New Orleans, on the possible extinction 
of yellow fever, and from which it appears that Auguste Frederic Du- 
troulau said in bis thesis, published in 1842, that an indispensable con- 



The Ship Origin of Yellow Fever. 16 



dition of the focus of development {foyer d' emanation) is its mari- 
time attribute." Nay, more, the examples are not rare of vessels in 
which yellow fever has declared itself spontaneously in the open sea 
(en pleine mer), and without having communicated with any infected 
land." He then reports a typical case, too long to be quoted, which 
occurred in 1833 in the brig Cuirassier, aboard of which Dutroulau was 
the surgeon in charge. 

In 1853, in the Archives Generates de Medicine, Dutroulau distin- 
guished the endemic or land miasms from the yellow fever poison 
which shuns the marshes. He said, yellow fever is limited to a very 
short distance from the sea-shore, whereas paludal fevers are ob- 
served wherever marsh miasm occurs, and authorizes the conclusion 
that the miasma of yellow fever derives one of its essential characters 
from the influence of the sea. More recently still, and in the very 
work quoted by Dr. Chaille in his report, Dutroulau declares that the 
essential and primary cause of yellow feveris localized on the sea — "an 
infection proper to certain maritime localities." 

I am now actively engaged in the preparation of my work to be 
entitled "The Tropical Atlantic Plague, Yellow Fever," wherein I 
shall show how simple and grand the truth is, as revealed hy history, 
coupled with a wide experience in several cities of numerous epidemics. 
The science of pathology is not so hopelessly without basis, as Dr. 
Chaille indicated when he confounds plagues proper, the pure con- 
tagia ever propagated from pre-existing cases, such as small-pox, 
with diseases like yellow fever of localized origin. Anxious as I am 
to see the work of the National Board of Health flourish for the 
salvation of our country, I trust to show yellow fever is an endemic 
of no land, in the sense in which the word endemic is defined by the 
profession at large. Once this is acknowledged, and the mercantile 
marine purified, yellow fever must become extinct. 

I am, sir, your obedient servant, 

EOBT. B. S. HARGIS, M. D. 

This was succeeded by the two following letters : 

New Orleans, March 31, 1880. 
Editor op the Pensacola Advance: 

Dear Sir — Permit me to furnish Dr. Hargis a brief reply, which will 
be final, because if I had time and inclination, which I have not, to 
engage in a newspaper controversy on the problem of yellow fever, 
I despair of either receiving or conferring benefit by controverting an 
opponent who so much misunderstands, and, apparently for this 
reason, misrepresents me. This is not the less discouraging because 



The Ship Origin of Yellow Fever. 17 

of my friendly and firm conviction that the misrepresentations are 
without intention or bad purpose. 

My first letter was designed to show how groundless was Dr. Har- 
gis' charge against the National Board of Health, to indicate how lit- 
tle provocation he had for denouncing with strongest condemnation 
and consigning to the vengeance of "the next decade " his brother 
physicians, — animated by scientific zeal, integrity and knowledge, pos- 
sibly as great as his own, and to intimate that he had misrepresented 
his true cause for his "strongest condemnation." His last letter, of 
March 27, fully confirms my positions in reference to these three points, 
and L very much regret that additional misrepresentations, some im- 
plied others clearly expressed, should tempt me again to weary your 
readers. 

For my own credit, and the honor of the position held, it is to be 
hoped that there has been misrepresentation (implied) as to my ''di- 
plomacy" and "lack of precision in the use of scientific language, "as 
to my "specious arguments based on false premises," as to my ignor- 
ance of the yellow fever literature of the English language, as to my 
being "blind or deaf to the clearest evidence, " and as to my woeful de- 
ficiencies as an "enlightened pathologist." I have long taken an 
humble part in medical literature, but am unaccustomed, and intend 
to remain unaccustomed, if silence will assure it, to such implications. 

Dr. Hargis persists in misrepresenting my views as to that ill-de- 
fined word "endemic," and upbraids me for the use of it with " mys- 
tery," but if used in a manner mysterious to him alone, am I respon- 
sible ? He misrepresents the value I attach to Dutroulau's evidence, 
and he misrepresents — apparently misled by another — that evidence it- 
self. He misrepresents my views as to the relationship between yel- 
low fever and such diseases as small-pox, failing here, as elsewhere, 
to understand even in what particulars I agree with him. Finally, he 
misrepresents my own and the correct signification of the word "ori- 
gin." 

Even should he accomplish the Herculean feat of convincing others 
than himself ' ' how simple and grand the truth is revealed by history, 
coupled with a wide experience in several cities of numerous epidemics 
(whatever this may mean) and that yellow fever originates on 
ships, he would then have done no more than prove where the disease 
originates, not how it originates, nor what the poison is, and would be 
just as far from the true origin of the disease as he would be from the 
true origin of a cat, — after having conclusively demonstrated that some 
cats have made their first appearance in his stable. Would any one 
discussing the "origin of man" deem himself answered by even the 
most conclusive proofs as to the mere place where man made his first 



18 The Ship Origin of Yellow Fever. 



appearance ? In such sense did I very manifestly use the word origin, 
and not in the sense misrepresented by Dr. Hargis. 

If having thus specified the more important misrepresentations, Dr. 
Hargis should fail to appreciate them, then one of two things : Either 
this failure to appreciate will be his misfortune and not my fault, or 
my ignorance of the English language is so dense that I ought to re- 
frain from abusing it further, to the vexation of Dr. H. and of your 
readers. Therefore I decline to enter into long and tedious explana- 
tions for the purpose of exposing in detail the misrepresentations which 
have been specified. Should any of your readers desire such explan- 
ations, they can find those most essential by a perusal, more critical 
and thoughtful than Dr. Hargis has given, of that very report which, 
in his opinion, "deserves the strongest condemnation." On the other 
hand, since the majority of your readers do not probably care a button 
about either the subject or misrepresentations, or explanations, they 
will rejoice that I hasten to subscribe myself, 

Yours, very truly, 

STANFORD E. CHAILLE, M. D. 



To the Editor of the Pensacola Advance : 

Sir — Dr. Chaille has anticipated a resolve which I had formed, that 
any technical discussion between us should cease in the public press. 
The medical profession shall judge who it is that "misunderstands" 
or "misrepresents." Argument and evidence can only be fairly met 
by argument and counter-evidence. I seek enlightenment, whilst 
standing firm by the knowledge so far gained. 

Dr. Chaille attempts to fasten on me some charge against the Na- 
tional Board of Health. So much depends on comprehensive and uni- 
form sanitary measures, that the influence of the medical profession 
should stand pre-eminent in the nation's councils, and no one shall 
excel me in fostering a just confidence in its chosen representatives. 

Fortunately, Dr. Chaille assumes the personal responsibility of de- 
fending views which I condemned, and data which I rejected as with- 
out foundation. Pie defines our relative position. I do not condemn 
the entire Havana Commission. Far from it ; — the researches of Dr. 
Sternberg promise to result in great good. 

When refusing to hamper the operations of the National Board, by 
opposition before Congress, it was desirable to indicate that my action 
was not dictated by personal preference, but simply by a sense of pub- 
lic duty. In my letter to Dr. Le Hardy I held myself free to take ex- 
ception to that which I deemed pernicious, whilst supporting the ex- 



Endemicity of Yellow Fever in Cuba. 19 

cellent general work of the Board. My Pensacola friends must have 
thought, for many years past, that I was fighting the winds, so con- 
stant and earnest have been my utterings on the subj ect of yellow fever, 
and its possible exclusion, not only from America, but all other lands - 
The time has come to show whether the opportunities enjoyed have 
been wasted, or whether another century must witness periodical out- 
bursts of malignant pestilence, owing to some agency which mysteri- 
ously haunts the minds of Dr. Chaille and others, as beyond the ken 
and grasp of man. 

Dr. Chaille requires, as the only measure of safety, non-intercourse 
as absolute as possible. He declares the ships are primarily contami- 
nated from the shore, catch the disease from land, whereas all yellow 
fever history points unmistakably the other way. 

I have a higher regard for your readers than to think, with Dr. Chaille, 
that the majority "do not care a button " about this subject. Attempt 
to fence in the Gulf or other ports, by impenetrable barriers, and then 
we may see what the non-intercourse programme implies. Our mer- 
chants care not less for Pensacola than the New Orleans citizens for 
their port. In the last they are raising one hundred thousand dollars 
this year for sanitary purposes to avoid the inconvenience of useless 
quarantine and non-intercourse. They are led in this by an experi- 
enced physician, Dr. C, B. White, whose influence in such a com- 
munity does honor to the profession, of which he has long been an 
energetic member. 

I shall in due course announce in which of the medical journals my 
views as to Dr. Chaille 's writings are to be amplified, and meanwhile 
I subscribe mj^self, 

Your obedient servant, 

ROB'T B. S. HARGIS, M. D. 

The charges and declarations made by Dr. Chaille, in the 
foregoing letters, are of far too serious importance not to be 
fairly and fully met by arguments and statements, which I 
respectfully submit to the judgment of the profession. In 
the first place I shall speak of the 

ENDEMICITY OF YELLOW FEVER IN CUBA. 

Dr. Chaille says it would be difficult " to cite a single 
Cuban authority of any weight in medicine," in opposition 
to the view of the endemicity of yellow fever. To speak 
more plainly, Cuban physicians advocate "local origin," 



20 Endemicity of Yellow Fever in Cuba. 

and being in this, in my estimation, a quarter of a century 
behind the time, it is essential that the National Board of 
Health be informed of the actual and substantial grounds 
for entertaining such an opinion. 

Dr. Chaille insists on the great value of experience on 
this question. No one doubts it ; but the most skillful hy- 
gienists and epidemiologists are not the busiest practition- 
ers who visit the sick. I have been familiar with yellow 
fever for forty years, but have learnt that sanitarians who 
have never witnessed an epidemic can grasp the practical 
questions better than I can. An episode in the history of 
American medicine may prove instructive and a warning 
to writers who belittle their adversaries. When Philadel- 
phia was scourged by yellow fever in 1793, Dr. Chas. Cald- 
well was a truly brilliant student of medicine. He was the 
first and last in charge of the city hospital and has described, 
in a graphic manner, the dread of contagion which caused 
medical men and students to fly, thus rendering assistance 
scarce. The nurses were few and inexperienced. The pro- 
visions and arrangements of the hurriedly prepared asylum 
were in all respects limited, ciude and insufficient. In fact 
the whole establishment being the product of but two or 
three days labor " was a likeness in miniature of the city 
and the time, a scene of deep confusion and distress, not to 
say of utter desolation." " No apartments being yet pre- 
pared for the use and accommodation of the medical assist- 
ants, I was obliged," says Dr. Caldwell, " to eat, drink and 
sleep (when indeed I was permitted to sleep) in the same 
room in which I ministered to the wants of the sick. And 
not only did I sleep in the same room with my patients 
but also at times on the same bed," receiving occasionally 
" on some part of my apparel a portion of the matter of 
black vomit, and I was inhaling the breath of the sick, and 
immersed in the matter which exhaled from their systems, 
every hour of the day and night." He often woke to find 



Endemicity of Yellow Fever in Cuba. 21 

his patient dead beside him. Under these circumstances 
Dr. Caldwell abandoned his belief in the contagiousness of 
yellow fever and published the fact. At a meeting of the 
Philadelphia Medical Society, in the fall of the year, he re- 
deemed a promise made to Dr. Eush and read a paper on 
the domestic origin of the disease. He was opposed by 
several who had left during the epidemic, and in the most 
dexterous manner he said, " Yellow fever has but just dis- 
appeared, the miasm productive of it having been distroyed, 
as it will always be, by the occurrence of cold weather. 
My wish, therefore, sir" (addressing the Chairman), "is to 
hear from the gentlemen arguments in favor of its foreign 
origin, drawn from what they have learned by their recent 
intercourse with it, in the way of observation as men of 
science, and of experience as physicians engaged in the 
treatment of it." 

" This I knew," says Caldwell in his autobiography, 
" would be sail and wormwood; because not a single indi- 
vidual who, as yet, had contended, in the present debate, 
that yellow fever was an imported complaint, had ever seen 
a case of it. They had all hurried into the country on its 
first appearance in Philadelphia, and had now but just re- 
turned, to instruct the community, including those who had 
met it, contended with it, and studied it, as the mystery of 
its origin." 

Dr. Caldwell has, and many since his time have, overlooked 
the fact that, as with a statesman defending a nation, who 
controls generals, or distant fields of battles, though himself 
not a warrior, so in epidemic times the calm and broad 
views of the events at many points, in a country so vast as 
this, give, the skillful scientific pathologists, a clearer per- 
ception than the local observer of the adverse influence he 
has to antagonize in order to limit the spread of disease. 
It is thus also with the logical mind building up a sound 
conception of the nature of plagues. He cannot afford to 



22 Endemicity of Yellow Fever in Cuba. 

overlook anything, or any one in the past, and, with far 
greater justice can we to-day, than ever before, apportion 
to Chisholm and Bancroft, Hosack and Kush, Chervin and 
LaKoche, the praise or the blame for the truths or errors 
they promulgated. Who more than Caldwell and Eush 
could vaunt a practical experience, and being trusted by all 
in the afflicted city, they imposed on the stricken a course 
of blood-letting and the famous " ten and ten dose of calo- 
mel and jalap? " Perhaps there is no living American 
who has seen more yellow fever than I have since 1859, so 
that I am entitled to encourage our unprotected hygienists, 
especially in the North, not to risk their lives, to add 
weight to their opinions, whilst engaged in the laborious 
duty of culling, for the common good, from the experience 
of centuries. Nay, more, the events recorded by unsophisti- 
cated minds, by young physicians, when careful note takers, 
rather than burdened with years and theories, will often be 
found to bear the impress of the most solid fact. • This is 
conspicuously the case with the greatest of the authorities 
quoted by Dr. Chaille, viz., Dutroulau. 

We can look back to-day with composure and compe- 
tent perception to the many fruitless efforts made to indi- 
cate the localities and circumstances charged with the 
" domestic origin " of yellow fever on American soil. The 
question, settled early by Tully and others of the broad line 
of separation between endemics, or malarial fevers of marshes, 
and the pestilence carried North annually right into the 
ports on the Connecticut, is still feebly agitated and periodi- 
cally demolished. Land malaria and filth on land are 
charged with the local production of yellow fever only by 
those who do not read and cannot observe. 

The " exotic origin " of the malady may be said to per- 
vade the American medical mind as the fashionable opinion 
of the day. So far so good ; but some land must be charged 
with the odium of developing this pestilence, since its local- 



Endemicity of Yellow Fever in Cuba. 23 

ized character is too striking to be ignored, and hence the 
importance of Dr. Chaille's remarks concerning Cuba. 

A very common, and amply justified, opinion is that yel- 
low fever poison developes and propagates outside the hu- 
man body, and it has been declared by such authorities as 
Jewell that " there is no adequate reason whatever for be- 
lieving that it attaches especially to, or is multiplied in, the 
bodies of the sick." The latest views promulgated tend to 
oppose the idea of the spontaneous origin of yellow fever 
anywhere. In a clinical study by S. M. B., in the April 
number of the American Journal of the Medical Sciences, it 
is stated that yellow fever "is reproduced chiefly, if not 
wholly, within the body." The indispensable " germ " 
spreading from man to man is at the root of this opinion, 
but I agree with Mr. Gamgee that "there is no foundation 
in fact for the plausible explanation of the propagation of 
the disease by the reproduction of the lowest organisms." 

With all these conflicting declarations before them, the 
National Board of Health very naturally sought to deter- 
mine whether Cuba constituted a primary and permanent 
home of yellow fever. In other words whether it is en- 
demic there as it was once supposed to be in New York. 
In attempting to settle this question Dr. Chaille, who has 
acknowledged his responsibility for this portion of the 
Havana Commission Eeport, neglects the common signifi- 
cation given by medical writers to the words endemic and 
endemicity. He says that " the word endemic will not be 
used to imply that either this, or any other disease, which 
there may be occasion to thus designate, owes its origin 
necessarily to local causes." Then why use the word at all, 
other than to indicate a disease peculiar to the people or 
the nation? That endemicity in Cuba in relation to yel- 
low fever is in a temporary or controllable condition is in- 
dicated by the statement that " the day may come when 
the people of the United States will demand whether their 



24 Endernicity of Yellow Fever in- Cuba. 

welfare would not be best promoted by suspension of inter- 
course with Cuba during certain months of the year." 
Since small-pox would probably be found " as exception- 
ally and almost as severely prevalent as yellow fever, it 
has also become endemic in Cuba," and to fix beyond perad- 
venture Dr. Chaille's position, the following statement may 
be noted : " It should not be forgotten that while none of 
the causes referred to suffice to always explain all the vari- 
ations in the prevalence of yellow fever, during certain 
seasons and years, yet that this terra incognita of this dis- 
ease is also a terra incognita for small-pox, malarial, and 
other diseases. Science has no right to expect explana- 
tions of the mysteries of the one, while still unable to solve 
the similar mysteries of other much more familiar and 
widely prevalent diseases." 

Small-pox has its home wherever man can live and be 
approached by other men. Malaria has a strictly defined 
boundary, as its source, as much as a river has in a moun- 
tain. Drain the land within these limits and malaria dis- 
appears. Kelapsing fever originated during the great Irish 
famine, and travelled across the Atlantic. The geographi- 
cal distribution of yellow fever and its relations to com- 
merce, wars and revolutions, are illustrated by an array of 
facts not to be surpassed in epidemiology and only equalled 
by the abundant data possessed regarding Asiatic cholera. 

Dr. Chaille has but sought to justify the utter confusion 
in which, to say the least, an irregular use of the words en- 
demic and endemicitv, has created in the minds of readers 
of his preliminary report. Since he objects to Webster's 
definition after Hoblyn, I have searched a few of the prin- 
cipal authorities whose works I possess. Dr. C. B. Wil- 
liams in his Principles of Medicine settles the question as 
understood by the whole profession. He avoids the ex- 
pression by certain causes " inasmuch as this involves a hy- 
pothetical signification of their modes of action." Endem- 



Endemicity of Yelloic F'ever in Cuba. 25 

ics he says " are instances of disease which may be said to 
dwell among the residents in particular spots ; hence they 
are called endemic in the people." His examples are ague 
and goitre. Other diseases are not confined to particular 
localities '*' although they infest some more than others." 
* * * * " They attack a whole district, a 
whole country — nay, almost a whole hemisphere These 
are called epidemics, like a blight or pernicious influence 
blowing on the people." 

Dr. Aitkin says, in his Science and Practice of Medicine, 
li endemic influences result from those conditions or agen- 
cies peculiar to a locality which favor the development of 
various miasmatic diseases, and may thus account for their 
s udden origin. Such diseases are then said to be endemic. 1 ' 

Dr. Koger S. Tracy, in Dr. Buck's Hygiene, speaking of 
endemic diseases, says : " The type and exampler of such 
diseases is the malarial fever, which takes upon itself so 
many forms and causes so much misery and so many broken 
constitutions in the West and South-west, and which shows 
itself with something less of intensity at various points along 
the Atlantic coast. Typhoid fever can almost be called 
endemic in the beautiful valley of the Connecticut, and 
tetanus in a certain district of Long Island. These diseases 
are due to local causes, and it is altogether probable that 
these causes will at some time be ascertained ; and when 
they are once known, means can be adopted for their ex- 
tinction." 

Dr. Dunglison, in his Dictionary on Medical Science, says 
" an endemic is owing to some peculiarity in a situation or 
locality. Thus ague is endemic in marshy countries ; goitre 
at the base of lofty mountains, etc. Some authors use the 
term in the same sense as epidemic." 

Dr. Daniel Drake, than whom it is not easy to quote a 
more precise author, whatever opinion we may form of his 
conclusions, anticipated, many years since, in his aetiological 



26 Endemicity of Yellow Fever in Cuba. 



deductions, all that Dr. Chaille implies when speaking of 
the endemicity of yellow fever in Cuba. Dr. Drake said, 
" whether the yellow fever of Havana originated there, or 
was introduced from abroad, we may speak and treat of it 
as a disease of that city ; seeing thata, lthough it is not ex- 
tensively prevalent every summer, it is never absent, and 
thus, if not a native, is a naturalized endemic" 

Now what influence has Dr. Drake exercised on the Pro- 
fession in relation to yellow fever? The hopeless confusion 
he launched the subject in, after the sound teachings of 
Tully and others, may be gleaned by the following. He 
said : " Is yellow fever, then, it may be asked, merely the 
remittent autumnal fever with which we are all familiar? 
The answer, according to these views of its origin is, that 
it is one of the varieties, as a tertian fever is another." 
That is where alone endemicity leads us, and the National 
Board of Health undoubtedly wished to know if the West 
Indian Islands were the plague spots whence yellow fever 
sprang, and was annually propagated. In other words, 
whether the source of the great stream of yellow fever, like 
the source of a river in a mountain, was not absolutely re- 
stricted to islands, of which Cuba is a type. 

Dr. Chaille has favored us with many useful facts and 
inferences relating to yellow fever. Every one of these may 
be cited as evidence against the domestic origin of yellow 
fever in Cuba, in plain medical language, against its 
endemicity in that Island. He says that " knowledge of na- 
ture's laws, of disease, of yellow fever particularly, and of 
other subjects relating to the present topic, convert the 
suspicion, justified by scanty historical records, into an abso- 
lute conviction that yellow fever was at least worse, in some 
of the West Indies with their first settlement by Europeans." 
No record or tradition lends the slightest support to the 
view that yellow fever reached the West Indies Islands be- 
fore the ships of Columbus and his followers. Indeed, the 



Endemicity of Yellow Fever in Cuba. 27 

first epidemic of yellow fever, that probably ever occurred 
in this world, was that carried to Barcelona in 1497 by 
sailors returning to that port from the second expedition to 
the " Indies." The second epidemic of which we have any 
approximately reliable notice, was that recognized as a 
"new disease" which was named " coup de barre" from the 
intense rachialgia, and which was introduced into the Antil- 
les by the ship Le Boeuf, from Rochelle, in France. Neither 
the West Indies in the Barcelona epidemic, nor Rochelle in 
the first invasions of the New World, had anything to do 
with the probable development of these epidemics, which, 
like so many others, in my opinion, emanated from the 
tropical Atlantic. 

But we may pass from inferences and suppositions which^ 
however interesting, have only a very limited scientific 
value, and truly does Dr. Chaille remark that, " though 
Spanish literature is unusually rich in valuable histories of 
Cuba, no allusion has been found justifying even a suspicion 
that yellow fever was known in the Island from 1655 to 
1761. On the contrary, repeated references are made to the 
remarkable salubrity of Havana, and the non-existence of 
any exceptional or devastating diseases during this in- 
terval." 

That Cuba is naturally a most healthy Island is proved by 
Dr. Charlie's statistics, which indicate, in the special case of 
Havana, a salubrity equal to the finest European and Ameri- 
can cities, if " endemic yellow fever," " endemic small-pox," 
and phthisis in people seeking a warm climate, are excluded. 
Not all the filth, so forcibly described, nor a tropical climate 
of the most definite character engender any plague there. 
As to yellow fever, it " habitually prevails in every place in 
Cuba from which reports were received, provided these 
places are of any size or commercial importance, and contain 
any considerable number of unacclimated persons to furnish 
food for the wide-spread poison." 



28 On Acclimation. 

No epidemiologist can miscontrue the meaning of the 
sentence I have marked in italics. An endemic attacks the 
few or the many which are subjected to the evil influences 
engendering such a disease. The very spot mentioned by 
Lind, in his Diseases of Hot Climates, as having proved fatal 
in the summer and autumn of 1766 to French settlers on 
the Escambia River is well-kuown to me, and frequently 
since, attempts at peopling that place have ended in the 
sickness and death of all who dared to sleep one night in 
that locality, in August or September. 

ON ACCLIMATION. 

I must also object jnost strenuously, especially when speak- 
ing of yellow-fever, to the use of the words acclimation, ac- 
climated and unacclimated. All persons with slight dif- 
ferences of race predispositions are liable to yellow fever, 
however long they may have resided anywhere on land- 
Protection is only absolutely gained by an attack of the dis- 
ease, which in some cases may be slight and barely percep- 
tible. My objection to the word acclimation extends also 
to the true endemic, for a wide experience of these maladies 
has proved to me that people inhabiting malarious regions 
suffer more the longer they remain there, and the fatal form 
of yellow disease, a malignant paludal fever, as in the cane 
brakes of Alabama, ultimately develops. 

Dr. Chaille " proves how erroneous is the idea that yellow 
fever is especially and exceptionally severe in the shipping 
and harbor of Havana. He has not stated what my own 
extensive and very precise inquiries have indicated, viz.: 
that the crews of ships frequenting all West Indian and 
Gulf Ports are protected to the extent of full 50 per cent. 
Besides this, many a healthy ship escapes the disease just 
like a large number of even " unacclimated " people pass 
into Havana, and even Vera Cruz, every year without con- 
tracting the disease. 



On Acclimation. 29 



The subjoined remarks, indicating that yellow fever de- 
pends on something more than local filth, are instructive, 
and indicate that the yellow fever poison is an element su- 
peradded to defective hygienic conditions : 

" There has been no intention to convey the idea that 
houses may not be found in New York and other American 
cities as foul as they can be, and, therefore, as foul as they 
are found in Cuba ; but in the former these evil conditions 
are seen as exceptions, confined to narrow, disreputable 
limits, while in Havana these conditions in the ' homes of 
the poor n are widespread and general. Moist, foul, stag- 
nant air, confined low to the ground, is found everywhere, 
so everywhere can be seen the refuse of fruits and vegetable 
substances, furnishing abundant materials for decomposition, 
while numerous turkey-buzzards, roosting on the trees and 
house-tops of populous cities, sufficiently testify to ample 
supplies for animal putrefaction. These gross insanitary 
evils are as abundant in Havana, where yellow-fever always 
prevails, as in Canton and Bombay, where this disease never 
occurs." 

" There is one more subject which deserves brief notice in 
connection with air- polluting causes and with theories main- 
tained as to yellow fever. Sanitarians were greatly offended 
by the burial ol the dead of Havana in its churches until 
1806, when the "cemetery of Espada " was established out- 
side the walls. In the course of years the growing city 
surrounded this cemetery, and to this was again attributed, 
among other insanitary evils, a bad influence on yellow- 
fever. Overcrowded with more than three hundred thou- 
sand dead bodies it was closed in 1871, since when all the 
dead of Havana have been interred in the new " cemetery 
of Colon," which is admirably located and too distant from 
the population to exercise upon it any evil influence. It is 
noteworthy that there has apparently been no abatement 
in the prevalence of yellow fever." 



30 The Ship Origin of Yellow Fever. 

THE SHIP ORIGIN OF YELLOW FEVER. 

Failing to determine the causes of endemicity and noting 
the perplexity as to what measure may be advocated for 
the benefit of Cuban Ports and the world trading with them, 
Dr. Chaille tells us " that the people must be provided with 
means to become intelligent, enlightened (especially in hy- 
giene.) prosperous, and sufficiently numerous to eventually 
gain both the knowledge and the power necessary to cor- 
rect their insanitary evils. This is not only the best, but 
the only means. Until their accomplishment (which the 
present generation will not live to witness) Havana will con- 
tinue to be a source of constant danger to every vessel within 
its harbor, and to every southern^ port which these vessels 
may sail to during the warm season." 

" While these are the conclusions of this Commission, 
there were formerly many, and there are still some few, 
who, without personal experience or extensive knowledge 
of this special subject, look upon it in a much simpler light. 
They pronounce yellow fever " a nautical disease," and 
seem to believe that if means were adopted to rid ships and 
harbors of the poison generated, as is alleged, and contained 
in them, there would be an end to it. Since this view 
leads to practical results of great sanitary importance the 
facts in the matter have been carefully examined in Cuba, 
and also the records of the facts in other of the West In- 
dies." 

" The only means " seem to me as indefinite and unat- 
tainable as any ever proposed, and Dr. Chaille" s declaration 
concerning the former, " many " and " still some few " who 
" without experience or extensive knowledge of this special 
subject," pronounce yellow fever a nautical disease, is in 
direct and flagrant defiance of all history. 

For twenty-five years I have sought allies and supporters 
for this truth from amongst writers of the past and my con- 



The Ship Origin of Yellow Fever. 31 

temporaries. I left the Medi cal School of Louisiana a believer 
in " local origin " on land like every disciple of Stone. The 
Northampton, direct from England, infected New Orleans in 
1853, and I purposely visited that ship to satisfy myself as 
to its condition. A new light dawned on me, but it was 
five years before I felt warranted in declaring, in direct op- 
position to every authority I could consult, that yellow 
fever was never a land malady, but always localized in its 
source on sea in the tropics. The few who have hinted at the 
nautical origin of yellow fever, have been men of excep- 
tionalty large experience. The individual cases of ships in 
which disease has been unmistakably developed are, as a 
'rule, singularly well recorded. They offer a striking contrast 
to the many, but utterly baseless assertions concerning the 
sites and circumstances of local origin on land. They have 
been recorded by contagionists and non-contagionists alike — 
though we must admit that many of the earliest and most 
instructive examples, relating to local origin in ships, were 
published by physicians who believed the malady would 
originate anywhere, under definite conditions of heat, moist- 
ure and foul effluvia. 

Those who have written with fairness and learning on 
yellow fever, have not ventured to explain away the pre- 
cise facts which abound, but which somehow failed to create 
the impression needed to formulate the law that " yellow 
fever is a naval malady of the tropical Atlantic, communi- 
cable to, and capable of, persistence on shore, but never pre- 
senting the feature of a land plague like cholera." It was 
most disappointing to me, at first, to notice that the ablest 
authors, in discussing the source of yellow fever, failed to 
appreciate this one fundamental idea, an adequate statement 
and demonstration of which was never in print until Mr. 
Gamgee treated the question last summer with learning and 
thoroughness. When he first broached the matter to friends, 
and before he knew of my writings, he was met by expres- 



32 The Ship Origin of Yellow Fever. 

sions of astonishment, precisely as I have been, even as late 
as at the Nashville meeting of the American Public Health 
Association. It is, therefore, a little surprising to find an 
attempt made to discredit the originality of this conception, 
and to overlook its important bearings on the present med- 
ical era. 

It is true that towards the close of the last century Dr. Grif- 
fiths of Philadelphia, in a letter to Dr. David Hosack, used 
the following words : " The disease called yellow fever — 
but which I call the ship fever of the tropical climates." 
It is not clear that he did not ascribe some influence in its 
production to the West Indies where, according to La Poche, 
Dr. Griffiths believed the fever was not apparently conta- 
gious, " but he thought it became so during the passage 
from the Antilles to the United States." Hosack, of all 
men, came nearest the truth, for he considered yellow fever 
to be the disease of northern men removed to the tropics, 
but he had not the data before him to limit its precise cen- 
tre of development. He classed it with plague, typhus, 
etc., apart from the pure contagia, " which are communi- 
cated exclusively by contact and under all circumstances ; 
the diseases of this separate class, which includes yellow fe- 
ver, he points out as ' specific," 1 but only in general communi- 
cable, through the medium of an impure atmosphere." 

Though Dr. Push ascribed the fever of 1797, at Philadel- 
phia, to a foul ship, direct from Marseilles, and an out- 
break at Kensington to a ship from Hamburg (both very 
possible occurrences in the days of sailing ships striking a 
southern course), he did not suspect that the disease was a 
pure ship fever. Dr. Caldwell's report of the sloop Mary, 
which had visited no sickly port, and produced yellow fever 
amongst several persons exposed to the effluvia of the hold 
after opening ports and hatches, was one of the earliest, fol- 
lowed at various intervals by carefully noted cases, a pe- 
rusal of which, as La Poche asserted, " willfully sustain the 



The Ship Origin of Yellow Fever. 33 

opinion of those who ascribe, in very many instances, the 
appearance and spread of the disease to morbid effluvia 
generated in the vessels themselves." Dr. Ferguson, of 
Demerara, Audouard, Dickson and Alison have spoken of 
the occasional origination of the fever on board of ships. 
Copland saw it on a slave ship and thought it might be 
produced where masses of human beings were congregated 
in the hold of a vessel. He said : " If this opinion as to the 
probable origin of the infectious poison be not admitted there 
is certainly no other deserving greater confidence." 

Dr. J. C. Faget of New Orleans, in his Memoirs on Yel- 
low Fever, published in 1859, accepts as most reasonable, 
Audouard's views concerning the outbreak of yellow fever 
in ships at sea (meme en pleine rner) as Dutroulau had de- 
clared in 1842. In the New Orleans Medical News and 
Hospital Gazette for January, 1859, will be found a letter 
in which I say, for the first time, that " yellow fever is 
neither indigenous to this country nor a native of any for- 
eign clime," and " that it is in the holds of vessels within 
the tropics a certain period of time, that are to be found the 
nidus in which the germs of yellow fever are engendered, 
developed and propagated, and from them, under favorable 
circumstances, disseminated on reaching inhabited shores, 
within certain degrees of latitude." 

Last year Professor Gam gee entered into greater de- 
tails and pointed to the conditions which localized the dis- 
ease, in its origin de novo, in the calm belts of the Atlantic, 
mainly on the western half, the originally infected ships in- 
fecting land and other ships, until the full sway of malig- 
nant epidemics might be witnessed under similar conditions 
in the West Indies and in our sea ports. In his first New 
Orleans lecture he defined the malady as a pelagic or ocean 
malady confined within definite limits in the Equatorial 
Atlantic, and whilst communicable to points most accessible 
to maritime commerce, never penetrating as a plague in or 



34 Dr. Chaille's Evidence . 

across continents. He likewise indicated how utterly with- 
out basis was the " germ " theory of the disease. The sap- 
posed vital cause, demanding progressive generation 
throughout time and restricted to reproduction like animal 
and vegetable forms is not only hypothetical, but at the 
root of a new hypothesis which represents the latest fancies 
of yellow fever pathologists, who refuse to acknowledge the 
possibility of the spontaneous development of any disease. 

They endow with life the essential elements of all trans- 
missible maladies. In this I believe them to be in error. 

Dr. Chaille must kindly enlighten us as to the many or 
few who, inexperienced or " without extensive knowledge 
of this special subject," have pronounced yellow lever "a 
nautical disease." I challenge him to support this state- 
ment by anything like adequate proof. 

DE. CHAILLE' S EVIDENCE. 

Three columns of the concise Eeport are devoted by Dr. 
Chaille to the origin of yellow fever in ships and harbors, 
in order to state the " facts " at variance with the view. 
The vast importance of setting this point at rest is indicated 
in a very peculiar way by Dr. Chaille. He says : 

" There is a final deduction of much scientific importance 
derivable from the conclusion that yellow fever never origi- 
nates on ships. This deduction will be better understood 
if preceded by the statement that the facts occurring within 
an infected place, and. bearing upon the questioned trans- 
mission of yellow fever, can be as well explained by infec- 
tion of locality as by infection through the movable things 
and persons in such locality ; and that therefore these facts 
as they occur outside of infected localities must be more 
particularly relied on to solve the question. Now, vessels 
— because of their restricted limits and of their small and 
more readily observed contents and population — are the 



Dr. Chaille'' s Evidence. 



places which present the most numerous and favorable op- 
portunities for the solution of all questions which relate to 
the modes by which the poison is conveyed to such places, 
as well as from thence to other places, and also to the con- 
ditions necessary for the propagation of the poison." 

It is clear from this and all other statements that Dr. 
Chaille considers " the facts now presented "*--** 
" tend to prove beyond question that the poison of yellow 
fever is on the shore, and not in the waters of the harbor P 

Now what are these convincing facts ? The reader is re- 
quested to peruse the three columns of evidence and to as- 
sure himself that my summary or criticism as follows, is 
justified. Dr. Chaille begins like many recent writers on 
yellow fever, vaguely discrediting inexperienced writers 
and observers, without enabling his readers to determine 
whom he is hitting at, or for what reason an invisible enemy 
is demolished. 

" Naval surgeons, and especially those among them 
charged with marine sanitation, are, of all other medical 
men, best entitled to credence and confidence in this matter. 
Evidence from two such French witnesses will first be sub- 
mitted, one of these being A. F. Dutroulau, ' premier medicin 
en chef de la marine,' who had more than twenty years' 
personal experience of yellow fever, particularly in Martin- 
ique, and the other being Beranger Feraud, who held the 
same high post in the French navy, and also had extensive 
personal experience. Each of them was charged at differ- 
ent epochs with the duty of preventing yellow fever on 
ships and in seaports ; and while surrounded for years by 
special opportunities for observation, was required by im- 
perative official duty to study particularly the causation 
and prevention of yellow fever." 

The evidence of Dutroulau, as given in my first reply to 
Dr. Chaille, is conclusive that this authority considered 
the essential element in the development of the yellow 



36 Dr. Chaille' s Evidence. 

fever poison as of maritime origin. And if Dutroulau's 
facts, as well as some later theory, had been quoted by Dr. 
Chaille, the readers of the concise report would have had 
some means of independent judgment. To choose what 
suits a simple hypothesis from the pages of a voluminous 
author, is not quoting " facts " as the fair premises of a syl- 
logism. 

This is not all. Beranger Feraud's " facts " are not cited 
for he has none ; he does not deem it necessary to specially 
consider the subject. Dr. Chaille quotes him as insisting 
on the isolation of ships from land, and states a fact that 
" the common experience of mariners in the ports of the 
West Indies teaches them especially to avoid the shore." 
It is truly astonishing to find such a statement, which I am 
almost tempted to style puerile, published in disproof of 
the ocean origin of yellow fever. Is it not certain that for 
one ship, in which the disease springs de novo, scores are 
infected, 'in epidemic times, in the same way as houses are 
in seaports ? 

Dr. Chaille does not say that he personally visited the 
shipping and acquired a knowledge of the striking differ- 
ences between foul ships carrying disease to Havana from 
the ocean/and the recently infected ships smitten in the har- 
bor. Had he done this, he might have had some facts the 
nature of which I shall specially detail in my work to be 
shortly published. 

The next authority, quoted by Dr. Chaille, counts for 
another authority but, so far as the report is concerned, 
not for another fact against the position I hold. Dr. Chaille 
says : 

" Dr. Fuzier, a French army surgeon in high official po- 
sition during that most favorable period for observation, 
1861 to 1865, when France occupied Mexico, and at that 
most favorable place for observation, Vera Cruz, denies ab- 
solutely the spontaneous origin of yellow fever on ships." 



Dr. Chaille 1 s Evidence. 37 

" Such, is the evidence derived from the highest French, 
authorities." 

Intending to analyze all these facts, the abundance oi 
quotations is to avoid the slightest chance of misinterpre- 
tation. " The experience in the Spanish navy is not less 
emphatic " than the French. Dr. de Caneda has " fre- 
quently " observed the first cases on board ships amongst 
" persons whose duty calls them oftenest to the shore." 
Could he have said " always " instead of " frequently," he 
might have been of some use to Dr. Chaille. Dr. de Can- 
eda and a special commission appointed to report on the 
questions propounded by Dr. Chaille, could, in truth, only de- 
clare what every tyro in a busy seaport in the tropics knows, 
where navies congregate, that those most liable to contract 
yellow fever are those who inhabit the arsenal, and who 
frequent the wharves. Dr. Chaille does not seem to have 
heard of the speed with which any prudent Commander in 
the American navy clears out of a port when an epidemic 
is threatened. That the shipping in harbor forms part, and 
a most dangerous part, of an infected seaport has been well 
and widely known for over three-quarters of a century. 
Did not Lind show that healthy ships put to sea might 
save those who boarded them, and that "during the sick- 
ness at Cadiz and Pensacola, the removal of the sick into 
ships which lay at anchor, in a pure air, produced the same 
happy effects? " 

Has it not often happened that a ship has crossed the At- 
lantic with a healthy crew, notwithstanding a protracted 
sail in the tropics, and yellow fever breaking out when the 
ship was being unloaded, the " vile " climate of the port 
has been charged with engendering a poison which had 
been days and weeks in process of development within the 
vessels ? As Humboldt (one of the despised philosophers, 
if we are to shun the teachings of those who have not stud- 
ied yellow fever clinically), said, " as malignant fevers are 



38 Dr Chaille' s Evidence. 



easily engendered, amid a large crew, crowded together in 
filthy vessels, the commencement of an epidemic dates 
pretty often from the arrival of a squadron." The people 
affirm that the disease has been imported from a neighbor- 
ing port, as it often, but far from invariably, has been. 

Reverting again to Dr. de Caneda's commission, Dr. 
Chaille tells us they had " not sufficient time to collect sta- 
tistical data in detail," for a " demonstration beyond ques- 
tion" of that which needed no demonstration, for it did 
not in the least bear on the naval origin of yellow fever i n 
the tropical Atlantic. 

" Fortunately, however," says Dr. Chaille, "that able and 
zealous officer of the United States, Dr. D. M. Burgess, 
* * * was enabled to collect statistical 

facts in detail, and to present a very valuable tabular state- 
ment of these tacts." The table is reserved for the final re- 
port, but Dr. Burgess asserts "that those vessels which lie 
at wharves suffer incomparably the most. Of 81 vessels 
discharging at wharves, in July, August and September ? 
1879, only one in lo escaped infection. " The liability to 
infection in this harbor is in an inverse ratio to the dis- 
tance at which a vessel lies from wharves and habita- 
tions." Moreover, there " is a striking difference in the 
chances of infection, when making comparison between the 
wharves and the open bay." Dr. Burgess has " no hesita- 
tion in saying that the nearer the vessel is to wharves 
and to habitations, the more it is exposed to infection,' ' 
and with a caution, which ma}~ be commended to Dr. 
Chaille's special attention, he concludes by saying that 
" statistical records are very desirable on all these points." 

Such is the evidence (?) — the whole evidence — every fact and. 
opinion — enumerated, which precedes the extraordinary 
conclusion of Dr. Chaille, which he states as follows : 
" While all freely admit that yellow fever finds a favor- 
able medium on vessels, especially in the parts where air is 



Dr. ChaUUs Evidence. 39 

confined, for the propagation of its poison, the facts now 
presented are totally irreconcilable with the theory of the 
spontaneous origin of this poison on ships." It is quite im- 
possible to give adequate expression to my astonishment 
at the complete misconception manifested by Dr. Chaille, 
of the ordinary meaning of the words " facts " and " evi- 
dence" He has simply ignored anything and everything 
bearing, even incidentally, on the possible origin of yellow 
fever in ships. Going out of his way to quote French 
Naval Surgeons, could he not find ample material ready at 
hand in the Annals of our Navy Medical Department ? I 
happen, by chance, to have on my table the Sanitary and 
Medical Eeports for 1873-4, by officers of the IT. S. Navy, 
in which Dr. Thomas N. Penrose reports on the yellow 
fever on board the U. S. S. Ticonderoga, at Key West, Fla., 
August, 18 7-A. This is one of many cases which will fur- 
nish food for reflection. 

That the Profession may distinctly understand the prac- 
tical result which I anticipate from proving that yellow 
fever is the ship lever of the tropics, I may at once state 
that its malignancy, when first introduced under circum- 
stances favorable to a high mortality, has a natural tend- 
ency to diminish. In a warm climate and in warm dwell- 
ings, it may remain over one, two or three years, but, as 
with cholera, its known tendency, even in the West Indian 
Islands, is to extinction. Fresh poison and fresh people are 
indispensable to its permanence. According to Dr. Chaille 
the endemicity in Cuba will insure the persistence of the 
disease, whatever measures might be adopted with the 
shipping. I do not agree with him, and believe that the 
exclusion of newly-introduced yellow fever poison could re- 
store Havana to the condition in which it was prior to 
1761, and that, at the worst, the local developments would 
admit of sanitarv control. The history of Jamaica, Marti- 



40 Dr. Chaille's Evidence. 

nique, Guadaloupe, and the Bermudas teaches this, if it 
teaches anything. 

Fierce in his attacks on the exotic origin of yellow fever, 
La Roche, armed at all points by evidence which he repro- 
duced fairly, whilst attempting to bend it in support of his 
views, admitted the absolutely incontestable character of 
the records of vessels "in which the yellow fever has truly 
originated and prevailed." I ask Dr. Chaille to analyze the 
numerous cases quoted by La Roche and explain how they 
can possibly be erased from the pages of reliable history. 
In the light of augmenting experience, apparently incom- 
prehensible and irreconcilable facts came to be understood 
and we now know how it has often happened that an epi- 
demic, in an American or European port, has succeeded the 
arrival of a vessel, with a clean bill of health, from a port 
which could not possibly be infected. Even taking such a 
case as that of the ship Eliza accused of carrying yellow fe- 
ver into Philadelphia in 1799, La Roche was not justified 
in dismissing all that was said, " inasmuch as she came from 
Leghorn, where the disease did not exist at the time, and 
has as yet never occurred." Hundreds of cases prove that 
she might develope the disease on the voyage as the Nor- 
wegian ship Skebladna did in 1877 on a passage of sixty- 
three days, laden with sweepings from the streets of Lon- 
don and long becalmed in the latitude and heat of Fer- 

nandina. 

The question before us stands thus. The old doctrine of 
"domestic origin" of yellow fever, wherever this occurs on 
land, has been abandoned by Dr. Chaille, who dared not at- 
tempt to prove it in Cuba. There the endemicity of yel- 
low fever — whatever that may mean — is precisely analo- 
gous to the endemicity of small-pox. Dr. Chaille, without 
supporting his opinion by facts, nor evidence of the slight- 
est importance, actually neglects the numerous statements 
of his leading authority, Dutroulau, that the essential ele- 



Dr. Chaille's Evidence. 41 

ments of yellow fever is of maritime origin. He denies 
that yellow fever ever originated de novo in ships. Where 
then is its sonrce? ISTo where ? The whole history and the 
geographical limits of the disease point to this as simply 
absnrd. 

But for the length of this article I would have commented 
on Dr. Chaille's extraordinary declaration, as to the im- 
possibility of defining the sources ot the special diseases he 
mentions. Resting satisfied with one example — the case of 
human tapeworms — what more do we require to learn, 
with a view to limiting their reproduction, than that they 
are always derived from eating raw meat. Measly pork is 
the immediate cause of taenia solium, and raw veal of tae- 
nia mediocannellata. Of all so-called fevers or epidemics, 
none present more clear and trenchant features than yellow 
fever, and its recognition, as an ocean pestilence, will contri- 
bute quite as much to the advancement of pathology as a 
science, as did the labors of the illustrious Louis in relation 
to the distinction between typhus and typhoid. 

In conclusion I shall quote a few words from a philo- 
sophical lecture, just published in the London Lancet, on 
the History of Mental Medicine, by Ball. He tells us, in 
the first place, to respect our ancestors. In the second 
place, to observe well, and in the third, to be sceptical ; 
and he explains the word scepticism as follows : " I do not 
mean by that, that morbid frame of mind which makes us 
receive all new conceptions with a vulgar irony, and which 
would become, in the long run, more destructive to the true 
interests of science than the most childish credulity. I 
mean by scepticism that negative virtue which consists in 
never accepting a fact without verifying it, an idea with- 
out discussing it, and which teaches us to yield, only when 
the laden mind comes to bend beneath the burden of proofs" 
* * * * "subdued only bv truth." 



PRACTICAL HINTS 

RELATING TO YELLOW FEVER PREVENTION* 



The signs of the current season are such as I have known 
to precede yellow-fever epidemics. The history of the dis- 
ease in this region is that there are years when the spread 
seems to be impossible, and there are others when all efforts 
fail to stem its course. The condition essential to an out- 
break is the arrival of infected shipping ; but from 1853 to 
1861, I treated cases annually, in vessels in our bay, and 
coming ashore — made no disguise of my mission, without 
exciting surprise, much less fear. The virulent epidemic 
of 1853 originated in New Orleans on the arrival of the 
ship " Northampton," direct from Liverpool, with emi- 
grants. False swearing failed to hide the deaths from yel- 
low-fever, which occurred in the Carribean sea, or the 
cases presenting themselves in the gulf, and amongst newly 
landed passengers. I personally investigated this case and 
know that the vessel never touched land between Europe 
and New Orleans, and was protected from any other sources 
of contamination, than that incidental to traversing the dan- 
gerous Atlantic calm belts, under conditions favorable to 
yellow-fever development. The out-break occurred early 
in the season, in May, and we became the victims of an ex- 
tensive epidemic, which had been introduced from abroad 
by an infected vessel. 

It was this case of the "Northampton" and its resultant 
evils, which made me waver in opinion as to the possible 

*From the Independent Practitioner, July, 1880. 



Practical Hints Relating to Yellow Fever Prevention. 43 



land origin of the disease, and which modified the course 
of my subsequent investigations, observations and thoughts. 
The lesson was too striking to produce any but the strongest 
impression, and I soon familiarized myself with the con* 
trasts exhibited by the numerous ships, exhibiting signs of 
having been poisoned in infected ports, and of those in 
which the disease had evidently broken out spontaneously. 
The many opportunities for study, in the eight years pre- 
ceding the war, satisfied me, first, that the epidemic of 1853 
had protected the majority of our people, hence the uncer- 
tainty of infection from communication with the shipping. 
Secondly, that the persistent gulf breeze, which renders 
Pensacola one of the most delightful cities in the South for 
summer residence, in all probability exercises a marked 
protective influence against yellow-fever, which revels in 
stagnant air. Thirdly, that the periods of high tempera- 
ture are not necessarily the periods of greatest danger to 
human life ; but cold nights succeeding hot days seem to 
check the discharge, from the system, of poison which might 
otherwise be forced out, and develop many case p of an ag- 
gravated type. 

Fourthly, that in years when an excess of ozone in the 
atmosphere in spring is attended by almost epidemic and 
very severe catarrhs, we are apt to have an auturrn with 
an atmosphere deficient in ozone, well adapted to favor the 
spread of yellow-fever. No example was more startling 
than in the condition of matters in 1878, when we escaped 
the epidemic by rigid quarantine. In no year have I no- 
ticed' better defined indications, which personal experience 
causes me to reckon as of special importance. 

We are having a repetition of 1878. I do not attempt 
to foresee the meteorological features of the succeeding 
months, but we have had the catarrhal fevers, and now we 
must look out against disease importation. No one is more 
conscious than I am of the slight scientific value of these gen- 



44 Practical Hints Relating to Yellow Fever Prevention. 

eralities, which, are mentioned to direct inquiries and not to 
stifle investigation. As practitioners of medicine, we form 
personal opinions, from local knowledge which helps us ma- 
terially in our work, and soon we shall have much greater 
precision and more rational deductions. I can, however, 
confirm an almost accepted truth in epidemiology, that the 
careful observer must watch the vital statistics of seasons 
preceding epidemics, to obtain useful etiological informa- 
tion. It is this which has inspired me with hope or fear, 
when witnessing the first instance of yellow-fever in the 
shipping in our port. In some cases I felt sure of exemp- 
tion, and, in others, of fatal consequences. 

Western Florida has furnished me with some singularly 
definite experiences, and whilst at one time witnessing the 
malady on the cleanest, driest and healthiest regions, as at 
Milton and Fort Barrancas, I can testify to the virulence 
of the malady in unwholesome and over-crowded dens. 
Here we have, fortunately in winter, a congregation of old 
hulks discarded for all other than the lumber trade ; the many 
annually lost and reported waterlogged on the broad ocean, 
were not liable to yellow-fever. When the pumps have to 
be kept going all the time, it is difficult, bat by no means 
impossible, to have fever developed. These old and defec- 
tive vessels have afforded me personal experience, in sum- 
mer, of the poisonous character of these emanations — for it 
was by concentrated ship poison I caught yellow-fever in 
1853, after having past unscathed through a number of ep- 
idemics. 

The malarial element on the Escambia, distinctly limited 
now as it was in the days of the French Huguenots, cited 
by Lind, cannot travel in ships at sea; agues cease and sail- 
ors improve every day after they leave port ; but it is quite 
otherwise on vessel? which have either caught or developed 
yellow-fever. 



Ocean-Infected Ships. 45 

OCEAN-INFECTED SHIPS. 

The resident in a Gulf port having daily intercourse with 
mariners, learns that the suffering at sea in the tropics are 
beyond description. Hailing from any quarter of the globe, 
the oppressed crews refuse to go below, and lie about on 
deck, seeking some means of relief by the working of the 
ship, in the deathly stillness of the " calms." At times a 
man ventures below and the foul forecastle seals his fate. 
He is buried at sea, having died of a nameless disease, which 
I know from analogous cases, reported by intelligent cap- 
tains and medical men, to be generally yellow-fever. But 
such a ship may enter our port, in ballast, without a death, 
and only an unusual sallowness and sickliness of the crews. 
They go ashore and arrange for discharging their ships and for 
cutting ports to load lumber. The laborers and carpenters 
engaged in these operations are the first to succumb. They 
are specially susceptible and are often the first and only 
ones to reach the foul bilge. It is only those who have 
smelt, the combined sulphuretted hydrogen and fetid am- 
moniacal odors, who can appreciate the character of this 
poisonous gas, incapable of supporting combustion and an- 
imal life. Dead rats and roaches by the bushel are not 
rarities, and I have seen the active bubbling of gas on the 
surface of the bilge, supplying a constant quantity of putrid 
vapor, which effectually displaces or precludes the entrance 
of fresh air. 

Ocean infected ships usually have rotton timbers, are not 
very leaky, come in sometimes from Rio with rock ballast, 
whereas, at others, they have a more dangerous ballast in the 
shape of coal, which is loaded in Wales to avoid the charge 
for relieving a vessel of other ballast. 

The merchant ships of the future should have water bal- 
last in perfectly tight tanks. Every part of the timber 
should be made impervious to wet and elements of organic 
decay. 



46 Simple Fever Carriers 

A ship may have an infected hold, as the result of infec- 
tion from land, so that whilst specifying the distinctive fea- 
tures of the condition of a sickly ship entering our ports, 
after having left any European port without possible yellow- 
fever infection, there are cases which may be confounded 
with it. Above all, we must state our positions fairly and 
truthfully, not attempting to prove too much, or reckless 
by disregarding sources of recorded facts, after the manner 
of recent writers, who declare the spontaneous origin of yel- 
low-fever in ships impossible. 

SIMPLE FEVER CARRIERS. 

I have vividly before my eyes the " Fair Wind, " a ves- 
sel now in this port, and which is not a yellow-fever ship, 
like those in which the disease has originated de novo. 
She came here in July, 1867, as clean, as pure and well 
equipped as any vessel I have ever seen of her kind. She 
brought the yellow-fever, and how ? Amongst her crew, 
who contracted the disease at Kingston, Jamaica, before 
sailing for the port of Pensacola. After the discontinuance 
of the disease on board, and though disinfected in the up- 
permost deck, cabin, forecastle, &c, she opened her hatches 
and port holes and proceeded to load ; not a single case oc- 
curred amongst the steamer's employes that could be traced 
to that source ; the " Fair Wind " was a carrier, but not a 
generator of that malady. 

Land infected vessels show signs of the disease usually 
after leaving an infected port, and rarely beyond the 4th or 
5th day. When a ship has been ten days at sea or over, 
the chances are she has a foul bilge and will infect all the 
susceptible people who enter her. 

Vessels from Eio coming to this port, if infected in Eio, 
show signs of the disease unmistakably south of the equator, 
and usually, south of the tropic of Capricorn. If the out- 
break be delayed until the line is crossed, the permanent 
infection of the vessel, originating in the ship, is highly prob- 






The Period of Incubation of Yellow Fever. 47 

able. Nothing but familiarity with this subject and with 
shipping, can enable a sanitarian to appreciate the sharpness 
of these distinctions. The most puzzling complications are 
due to the vast difference between men as to constitutional 
pre-disposition. In yellow -fever, as in every disease, the 
study of diathesis, susceptibility, cause of immunity, may 
be placed in the first rank with a view to intelligent rec- 
ords. 

Medical men especially connected with Southern ports, 
should, in tracing the history of a ship, obtain from the log 
an account of her course. A sailing vessel from Europe 
making for New Orleans, has to keep far out on the Atlan- 
tic and strike a southerly course, to avoid the opposing 
gulf stream, and this is a circumstance which has specially 
attracted Mr. Gamgee's attention, accounting for the rarer 
out-breaks on vessels leaving for Europe, than those com- 
ing from Europe or sailing into the gulf from the southern 
hemisphere. Every degree north that is past affords a rel- 
ative protection, but the winds and currents which impel 
the vessels northward, exert a favorable influence on the 
health of the crew and passengers of ships at sea. 

Indeed, it is under these circumstances that even suscep- 
tible crews suffer little, or not at all, in an infected ship, 
until she reaches a port and is opened out as in the cele- 
brated case of the "Anne Marie," which left Nantes for Ha- 
vana on the 12th of May, 1861, started healthy on her re- 
turn voyage on the 13th of June, and seventeen daj^s after 
leaving port had a case of yellow-fever on board. The dis- 
astrous consequences which ensued in and around St. Na- 
zaire, in the north of France indicated that the northward 
travel of yellow-fever is not impossible, though ships are 
much relieved by stiff' trade winds. 

THE PEKIOD OF INCUBATION OF YELLOW- FEVEK. 

Slowly, but surely, have my eyes been opened to the folly 
of confounding natural phenomena, in relation to disease. 



48 The Period of Incubation of Yellow Fever, 

I appeal to medical men to abandon the talk about "germs" 
until "germs" are proved to exist. I have sinned like my 
colleagues, but the evils attendant on the use of words 
which do not implicitly convey a truth, have taught me a 
lesson. It is a fact that the development of fecundated ova, 
the embryonic stage of every known organic form, demand 
specific and invariable periods of time. A female acarus 
lodging on the human skin, has to produce the germs to 
induce the general and appreciable signs of itch. This 
takes time. The poison of small pox requires a definite 
and almost invariable period of latency or incubation, to 
overwhelm a healthy person. Not so with yellow-fever. 
All the statements made in the past must be carefully scan- 
ned, and it will be found, that where a period of latency ex- 
ists, between exposure to the poison and manifestation of its 
effects, this period is usually very brief and extremely un- 
certain. It varies with the cases and with the epidemics. 
The simultaneous manifestations of the disease in two or 
more persons exposed at the same time to the poison, often 
observed, may be explained on the principle of poison doses. 
There are many drugs given in like quantities to two simi- 
lar individuals, at the same time, which produce a defi- 
nite result at the exact same time. Bat strengthen the 
dose, and as with yellow-fever, the effect is immediate. 
From the earliest careful observations of this disease, pro- 
duced by foul ships, on susceptible people in ports, the in- 
stant sickness of persons who have breathed the air of the 
hold has been noticed. I returned to shore from an infected 
ship in 1853, and remarked to friends who met me, that I 
was never so sick before in my life, as I was then. They 
gave me brandy ; I rejected it and took another drink with 
like effect. All the premonitory signs of fever seized me 
at once, and next morning I was transferred to Milton, 
which I reached in an unconscious state, and remained so, 
more or less, for six days, with marked symptoms of yel- 




The Period of Incubation of Yellow Fever. 49 

low -fever. I convalesced on the seventh day from the time 
of exposure and commencement of sickness. The same 
season a carpenter, who left Milton as a refugee to escape 
yellow-fever, went to Coffee County, Alabama, and returned 
after the first frost. He went straight to the house of his 
late friend Trammel, who had died in the summer ; the 
house had been kept warm and, after entering Trammel's 
bed, he was forthwith seized with the premonitory signs of 
yellow-fever and I treated him. 

These are not rare though somewhat exceptional cases, 
and the experience in northern ports that people who have 
remained healthy five or six days at sea, may be regarded 
as free from the poison, is to a great extent indicative of 
the prompt action of the yellow-fever poison. The type of 
the disease varies within certain limits strikingly, but 
every time has the same uncertain invasion which is totally 
unlike the latency and invasion of true fever. The well- 
marked supra- orbital and other pains, with or without rigors, 
supervene in one, two, three or four days, and rarely longer. 

These points have a most important bearing on the pre- 
vention of the disease, and, guided by them, we can readily 
understand how ship infection, the inevitable precursor to 
port infection, must be controlled, whilst the people carried 
are much more easily dealt with, owing to the brevity of 
the latent stage. In six years we have had no yellow-fever, 
but quarantine measures have been fairly carried out, and 
have sufficed in conjunction with natural tendency to ex- 
ceptional atmospheric purity, thanks to persistent natural 
winds peculiar to this region of country. 

Pensacola is by no means a model of sanitary arrange- 
ments. We might easily have efficient drainage, which 
we lack. We have plenty of space and porous soil, so that 
until the town is more populous and crowded, we may es- 
cape the visitations of typhoid and other fevers or great 
mortality from cholera, should it be introduced. We have 



50 Prevention of Yellow Fever. 

probably the healthiest city in the United States, and the 
infant mortality is exceedingly slight. I may define it a 
rural port, sheltered by healthy piney woods, and, thanks 
to the breeze, free from the heat diseases of inland, and of 
other cities on this and even more northern latitudes. 

Well have I understood, as a resident in Pensacola, the 
remarks frequently printed on the salubrity of the West 
Indian Islands, such as Curacoa, and how exactly similar 
the history of yellow fever here is with that of any other 
tropical port. 

PKEVENTION OF YELLOW FEVEK. 

Every eye witness of a city, during an epidemic of yel- 
low fever, has occasion to deplore the absolute helplessness 
of citizens and physicians in controlling the spread or an- 
ticipating the course of the plague. The well-founded 
opinions of the rarity of personal contagion, under certain 
circumstances, coupled with a large body of protected 
people, as in New Orleans, may be recognized as having 
materially favored the congregation of gossiping citizens 
in infected houses and localities, and thus, even by the well, 
the disease has been carried into many a house. The time 
was when, with less sanitary rule than is now enforced, a 
crop of yellow fever cases led the curious and the charit- 
able, the friends and the strangers who had no reason to 
fear an attack, to congregate, especially at the beginning of 
an outbreak, just like people run to a fire. 

The now acknowledged transmissibility of the disease 
leads to the imposition of wholesome restrictions. Never- 
theless, taking a case like that of Memphis, depopulation 
and isolation failed to arrest the malady before frost. The 
reason for this is, in all probability, that the impure air, 
poisoned in almost unlimited masses, in hospital wards and 
houses, is free to move and passes laden from block to 
block and street to street, until the sparsely inhabited sub- 



Prevention of Yellow Fever. 51 

urbs and open country cut it short by abundant atmo- 
spheric dilution. 

As a ship fever this malady is ever engendered by vola- 
tile matter, or matter suspended in moist, warm air, emerg- 
ing when the hold is opened, to poison the forecastle, the 
cabins, adjoining ships and houses. A slight breeze hast- 
ens its transit, but often neutralizes it. It does not go far. 
A contaminated house on a wharf does not transmit by 
fomites, "usually carried by man, the disease to a distant 
point of the port. Its proximate growth and a continuous 
current are marked in its course and stages by human vic- 
tims. 

I quite concur with Mr. Gam gee that currents of pure 
air, driven through and through infected places, constitute 
the most reliable means to dilute and ultimately to destroy 
the poison. The only danger is that atmospheric dilution, 
up to the present time, has implied a city's doom — a whole- 
sale infection. In grappling with the great difficulties 
which present themselves, as a believer in the oceanic char- 
acter of yellow fever, I must first and foremost attend to 
ship sanitation. Medical men are not engineers and ship- 
builders. Had they known how to advise, the practices 
commonly witnessed in gulf ports would long since have 
ceased. 

The problems relating to ship ventilation and pumping 
the bilge water are of the highest importance ; but I could 
not treat these subjects technically, and I desire to restrict 
my observations to a few reforms and procedures which 
admit of prompt attention. 

So far as the ship is concerned, it should not be emptied 
of solid cargo until it is freely exhausted of its gaseous 
contents. All that is then removed from the ship should 
be freely aereated by positive currents of air, and in many 
cases there is no objection to sulphurous acid fumigation. 



52 Prevention of Yelloiv Fever. 

The empty ship can then receive in its bilge some fresh 
burnt lime, and this may be sprinkled with advantage 
where foul gases may emanate. The word cleanliness im- 
putes, then, al] that has to be secured ; and by cleanliness 
and free ventilation, with thorough liming, a vessel can be 
purified. If, however, a low temperature can be secured, 
any way below 32° Fahr., and made* to penetrate some- 
what, the poison can certainly be destroyed. 

Mr. Gamgee has suggested to me a means whereby the 
foulest timber can be purified by hot drying oils, which 
destroy all moist organic matter, and render the wood ever 
after impervious to moisture or elements of decay. The 
hot varnish could be applied to the whole interior of the 
ship with great advantage. An impermeable purifying 
coating may prove a great boon, and this constitutes one 
of the points which Professor Gamgee intends to carry out 
in his fever-proof ship. 

The great advantage of having ships carrying skilled 
men and appliances for disinfection, is that infected vessels 
need never touch land until they are made safe. It is a 
bright idea, and could undoubtedly be carried out into prac- 
tice in our gulf ports. 

Stations, such as the one at Ship Island, may be adopted, 
but we are threatened, with that great impediment to com- 
mon sense legislation in sanitary matters, by divided coun- 
sels within states, and inadequate national administration. 
A sanistation could easily be provided for Havana by the 
Cuban government, and seeing how effectually the Spaniards 
have excluded yellow fever from their European Atlantic 
ports, it is to be hoped they may disregard the recently 
uttered statements, that Cuba is to be the permanent hot 
bed of a naturalized pestilence. 

I shall not attempt much, on this occasion, in relation to 
prevention of yellow fever on land, but I am happy to have 
been the first to witness Mr. Gamgee's experiments, whereby 



Prevention of Yelloiv Fever. 53 

forced ventilation of rooms, with filtration and effectual 
disinfecting of air is rendered possible. He has designed 
an apparatus which he calls the " circlair," which enables 
us to shut up a room and practically isolate the volume of 
infected air, which is abundantly purified and displaced 
by fresh air. 

The poison which seems to travel on the roads and side- 
walks, with the volume of heavy air dropping from infect- 
ed houses, can, in my opinion, be better destroyed by hot 
lime than carbolic acid. I object to this offensive com- 
pound, and believe, that irritating and fetid vapors have 
only found favor, because people have been led to suppose 
they must do good, and that their presence was unmis- 
takable. 

I do not think the yellow fever poison is difficult to 
destroy, but we must not be idle when a case indicates its 
location. Simple means will effect much, and I am in 
favor of prime attention to the foul gases of ships, the foul 
air of cities, and notably of the sick room. Control these, 
and much has been done to control the malady. 



THE MOST RECENT UTTERANCES ON ACCLIMATIZA 
TION AND ENDEMIC1TY 



ON ACCLIMATIZATION. 

The 1880, August number of the New Orleans Medical 
and Surgical Journal contains an excellent article by Dr. 
Chaille, on acclimatization, or acquisition of immunity, from 
yellow-fever. 

Having ventured to take exception to the preliminary 
report of the Havana Yellow-Fever Commission, and 
especially to the lack of all, in the nature of true evidence, 
adduced, in opposition to the nautical origin of yellow-fever, 
I am all the more anxious to give my hearty approval to an 
entirely new departure, on the part of Dr. Chaille. It 
will be seen that I have spoken of immunity from yellow- 
fever being alone obtained by an attack — mild or severe — 
of the disease. 

Dr. Chaille, while in Cuba, gathered from eminent phy- 
sicians a number of yellow-fever cases in Cubans — not only 
born — but always residing in Cuba. A very intelligent 
minority of the medical men of the Island regard immu- 
nity as only acquired by an attack of the disease. 

Heinemann reports, in 1879, " until lately the physicians 
and people of Vera Cruz, supported, with fanaticism, the 
dogma that natives were absolutely exempt from yellow- 
fever. But the fearful epidemics of recent years (1875, 
1877, 1878,) have worked a change ; for so many native 
children and adults suffered that the truth could no longer 
be denied that they do not enjoy an absolute immunity." 
*From the Louisville Medical Herald, September, 1880. 



On Acclimatization. 55 

By far the most interesting and conclusive evidence is 
afforded by Dr. Chaille's observations in relation to New 
Orleans. He says: "In 1851, the medical profession of 
New Orleans was almost unanimous in teaching that thqse 
born in that city were not liable to yellow-fever. Prof. 
Warren Stone, my teacher, was one of the very few who 
taught that Creole children did have yellow-fever, often 
in a form too mild to justify an absolute diagnosis." 

Dr. Chaille has lived to find that Prof. Stone's view has 
triumphed, and that the change has been so complete, he 
attributes "chiefly to the fact that, until 1858, New Orleans 
was ravaged by almost biennial epidemics, while since 1858, 
there have been only two serious invasions, in 1867 and in 
1878. The longer the intervals between epidemics, the 
larger necessarily must be the number of those who have 
failed to acquire immunity, and the more glaring becomes 
their liability to the disease. This is the explanation of 
the very old observation, that, the longer the absence of an 
epidemic from a place, the greater the susceptibility of its 
inhabitants. 

" Wherever yellow-fever occurs only occasionally, as an 
epidemic, there the Creoles are manifestly liable to the 
disease ; wherever it prevails habitually, there the Creoles 
appear to enjoy a very great, if not absolute, immunity ; 
and the fact that the white natives of a place do enjoy 
this comparative immunity, is good evidence that the poison 
of yellow-fever prevails habitually in this place. Hence, 
the important practical conclusion that the stranger should 
beware, during the warm season, of every place in Cuba or 
elsewhere, of which the natives boast, that while the for- 
eign born habitually, they never suffer with yellow- fever/' 

Neglecting much instructive matter, for which the reader 
can refer to the original article, it will be seen that Dr. 
Chaille endorses my statement at page 28, in the follow? 



56 On Acclimatization. 

ing words : " The only known mode of acquiring immu- 
nity from every other non-recurring disease is to have one 
attack ; and, so far as yellow-fever is concerned, while va- 
rious modes are claimed this remains the only one so cer- 
tain that no one whatever disputes it." Susceptibility to 
the poison is sometimes unaccountably diminished. He 
says: "facts will now be presented in proof that immunity 
from yellow-fever is acquired by a large majority of the 
natives of infected places, in the same manner if is ac- 
quired by unacclimated immigrants, and in the very same 
manner that immunity from every other non -recurring 
disease is acquired." 

Dr. Chaille appends a table, consisting exclusively of 
official data of population, from the United States census, 
and of deaths from the Board of Health of New Orleans. 
A second table consists of results obtained by calculations 
based on the original data in the first table — calculations 
designed to facilitate the interpretation of those original 
data. They date back to 1856 — that is as far back as au- 
thentic records can now be procured, including those most 
disastrous epidemics — 1858, 1867 and 1878. 

Until 1858 the great majority of the medical profession 
of New Orleans taught, with as much vehemence, as some 
few of them still do, and as nearly all the physicians of 
Havana and Cuba now teach, that the native-born Creole 
children and adults enjoyed absolute immunity from yellow- 
fever. 

Dr. Chaille has classed his conclusions under six heads : 
First, There is an enormous excess in the deaths of chil- 
dren, under ten years of age, during every epidemic year ; 
and this mortality occurs during the very months when 
yellow-fever devastates the city. 

Second. The statistics turn aside from the simple and 
reliable tally of the sexton, and become dependent on the 
di agnostic skill and theories of the doctor, since simul- 



On Acclimatization. 57 

taneously with yellow-fever there is always an enormous 
increase in deaths from "bilious," "congestive," "pernic- 
ious," malignant," fever, as well as by typhus and typhoid. 
Not verv nattering to the doctors who have hitherto failed 
to perceive they were recording a tale of singular inconsis- 
tency and incompetency, which " the sexton's tally " in Dr. 
Chaille's hands has just exposed. 

Third. Yellow-fever has not only been confounded with 
"malarial fever," since all these deaths, added to those of 
yellow-fever, fail to sum up a total, equal to the excess of 
deaths, which invariably occurs during epidemic years. 
Faulty diagnoses seem to include convulsions, cerebral 
congestions, and that everlasting ghost of mothers — "teeth- 
ing." With such a confession or exposure of prejudice or 
downright stupidity, who can be astonished that the aver- 
age medical man knows nothing of the origin and nature of 
yellow -fever. 

Fourth. Accepting the excess of children's deaths, in epi- 
demic years, as due to yellow-fever, the comparative suscep- 
tibility at different ages, can be calculated. There was an 
increased mortality, but slight, in children under one year. 
It was much greater between 1 and 2 years. Enormous in 
children from 2 to 5 years old. So that there were 89.4 
deaths in every 1000 of those in 1878, in place of 19.6 deaths 
in every 1000 in the non-epidemic years of 1877 and 1879. 
This, more than quadruple increase, is not equalled at any 
other ages. Dr. Chaille grapples with an anomaly exhib- 
ited by the epidemic of 1858. 

He says : " When it is known that the population of 
New Orleans had been subjected, so shortly before, to the 
three violent epidemics of 1853-'4-'5, and that during this 
prosperous period of the city's history, unacclimated im- 
migrants, chiefly from 15 to 40 years old, flowed to it in 
numbers far greater than subsequently, no one will be sur- 
prized to find that the mortality in 1858, compared with 



58 On Acclimatization. 

1878, was less in those under 15 years, and greater in those 
from 15 to 40 .years of age." , 

Fifth. "Accepting the conclusion, drawn from the ceme- 
teries, that the excess of deaths during an epidemic are due 
to the disease causing the epidemic ; and, again, taking the 
1878 epidemic as an illustration, we are forced to admit 
that somewhere between 1406 and 2023 children, under 10 
years of age, must have been killed by yellow-fever." Dr. 
Chaille attempts to deduce the number of children protected, 
having recovered, and these could not be less than 6,000 ; 
but probably much more, since, the younger the children, 
the less fatality amongst them from this disease. 

Finally. Dr. Chaille wisely refers to mild, benign, 
aborted or bastard yellow-fever, granting immunity, and 
which is recognized by physicians of noted skill. 

I cannot resist quoting a paragragh, which affords me an 
opportunity of directing attention to the opinions of a very 
distinguished British physician. Dr. Chaille says : " Blair, 
the unsurpassed classical student and historian of the epi- 
demic of British Guiana, 1851'— 4, states that the very first 
cases occured among little children, and that the attacks of 
others were numerous and repeated. Infancy was one of 
the most favoring causes of the action of yellow-fever poi- 
son. The constitution of the new born or young white 
Creole was highly susceptible. He or she was truly in the 
category of new comers. In 1851 yellow fever had been 
absent from British Guiana for six years — since 1845." 

Dr. Daniel Blair, thus justly eulogized by Dr. Chaille, 
was Surgeon-General of British Guiana in .1852, when his 
work reached a third edition. He states that, when the ep- 
idemic of 1837 occurred, those who had seen the disease in 
1819, had retired from practice, or were dead, and had left 
no record of its local peculiarities and treatment. When, 
in 1852, he attempted to trace the disease to its source he said, 



On Endemicity, 59 



"sufficient evidence has been elicited from the last epidemic 
to show that our inquiries must be directed to the sea-shore." 
And unable to perceive, in common with many others, that 
ships had infected the country, his perception was, never- 
theless, quick enough to make him say " some new element 
is required in the generation of yellow-fever, beside what 
is to be found annually within our embankments; and it is 
in all probability dependent on a sea change." 

II. 

ON ENDEMICITY. 

Dr. S. S. Herrick, one of the editors of the New Orleans 
Medical and Surgical Journal, in a review at page 142 of 
the August number, says : " We do not regard the term 
" endemic " as properly applicable to yellow-fever in New 
Orleans." * * * "An endemic should prevail in its 
habitat every year ; not so with yellow-fever at New Or- 
leans." Further on he remarks that, the doctrine of yel- 
low-fever endemicity at New Orleans, besides being scientifi- 
cally unsound, is ruinous to the city's commercial pros- 
perity.. 

" The suicidal policy of a portion of our citizens in pro- 
claiming to the world that their soil is incurably plague- 
stricken, has no parallel in this country, nor probably in the 
whole world." Dr. Herrick has evidently not read the yel- 
low-fever literature of his country, if he believes the words we 
have italicized. The indignant remonstrance of the in- 
spector of vessels of Philadelphia in 1793, Dr. J. Hutchin- 
son — who denied that the fever was " an imported disease, 
is before us. Dr. Rush, we well know concurred, and Cald- 
well echoed their sentiments. 

As late as 1819 we find Dr. Samuel Emlen producing a 
statement relating to Philadelphia, "as additional confirma- 
tion of the disease occuring without the slightest founda- 
tion for tracing its origin to a foreign source." 



60 On Endemicity. 



Dr. Thomas Lawson, Surgeon-General, in his statistical 
report, during the sickness and mortality in the Army of 
the United States, in 1840, said : " The experience of sev- 
eral centuries teaches us, that the cause of tihis fever is 
perennially present in our Southern cities. Indissolubly con- 
nected with our soil and climate, it maintains the same re- 
lation towards the animal system as the malaria of our 
Southern low lands." 

I allude, casually, to one or two references, which indicate 
that the people of America have, ever since yellow-fever 
invaded our ports, blamed their soil for it — so much so that 
the eloquent words of Dr. Francis before the Third Na- 
tional Quarantine and Sanitary Convention, held in New 
York in 1859, never can be forgotten ; there he vindicated 
the City of New York from the imputation of being the 
birthplace of yellow-fever. He spoke of it as engendered 
on ship-board, in healthy vessels sailing from ports diseased 
of yellow-fever. He complained loudly of those citizens of 
America who affixed to this noble country the stigma of 
producing yellow -fever. Nevertheless scores of partial ob- 
servers, ignoring the past, the experiences of which can 
only be made available by industry and patient investiga- 
tion, if the truth be sought, have steadfastly adhered to the 
local origin of yellow-fever in our ports, and the last strong- 
hold of this baseless and infamous theory is New Orleans I 

Can we be astonished if Griesinger, in his treatise on in- 
fectious maladies, published in 1868, should say "yellow- 
fever develops under the influence of general climacteric 
conditions ? It is essentially a disease of the Western Hemis- 
phere, of the West Indies, and of the American Continent." 

The mere quotation of this sentence suffices, I hope, to 
condemn the unfounded assertions, which, to this day, pass 
current as worthy of report. 



On Enchmicity. 61 



Dr. S. S. Heriick must know that, now the evidence re- 
lating to the nautical origin of yellow -fever is, in a substan- 
tial measure, before the world, and no one has dared to 
produce that which does not exist, counter evidence, to dis- 
pute it. His clear endorsement of my views as to the en- 
demicity of yellow-fever, I acknowledge, with thanks. He 
asks some questions which familiarity with the yellow- 
fever history would have indicated as entirely irrelevant. 

It is, perhaps, only fair to my case, and certainly fair to 

Dr. Herrick, to quote verbatim the extraordinary questions 

he has proposed. 

He says : " If the fever springs from the tropical seas of America, why- 
does it not become diffused throughout the warm waters of the Atlan- 
tic basin, at least, and thus infect all its shores? Having reached the 
western extremity of the Mediterranean Sea, and the coast of Spain, 
why should it not have extended eastward its whole length? Why is 
it not an every day occurrence for vessels, sailing between Europe and 
New Orleans, to catch the yellow-fever in the infected Gulf of Mexico ? 
Why does yellow-fever prevail annually ashore at Vera Cruz, and never 
on the shipping, which has to be a mile distant from shore ? Why are 
vessels lying in the harbor of Havana, which discharges and receives 
cargoes by lighters, and whose crews are not allowed to go ashore, so 
much less likely to become infected than those which lie at the wharves? 
Until the above inquiries are answered satisfactorily, we ask to be ex- 
cused from accepting any dropsical theory of the origin of yellow fever. ' ' 

They have been answered repeatedly by the events of 
past times. The numerous and cogent reasons which ex- 
plain why certain animals, like the herring, do not increase 
m numbers to the exclusion of all others, mav be cited in 
relation to an universal law of limitation of development. 
Who ever suggested that the Gulf of Mexico was itself in- 
fected, or that the Atlantic ocean waters themselves, under 
the benign influence of air, sunlight, and electricity, could 
produce yellow fever ? Dr. Herrick has erected a house of 
cards to experience the gratification of its demolition. The 
sailors on such ships as the Excelsior, so long as they keep 
above deck, are usually exempt of the products of foulness 
which arise from the imprisonment of Atlantic Ocean- 



62 On Endemicity. 



ivater and products in a ship's bilge, or in rotten timbers. 
When, in 1840, the General Board of Health met in London 
to report on quarantine, what did they say : "A foul ship 
is not only a centre of disease to those on board, but a source 
of disease to her neighborhood." Whilst condemning the 
quarantine establishments, the report states " that typhus 
and other dangerous epidemic diseases are frequent on board 
merchant seamen vessels at sea and in port, for which no 
effectual or suitable provision is at present made." Dr. 
Herrick allies yellow fever with typhoid — the typical land 
endemic whose periodical development, de novo, in our 
mountain ranges and elsewhere, is almost demonstrated. 
The analogy between yellow fever and typhus is universally 
acknowledged, whilst recognizing some marked and unfail- 
ing points ol demarcation between them. Surely typhus 
may be regarded as a specific disease, due to a specific 
poison in foul, over-crowded habitations, but no modern 
pathologist can ally typhus or yellow fever with small-pox, 
the type of the purely contagious diseases. It is its place 
in nature, which has been, for the first time, defined by the 
believers in the naval origin of the yellow fever, in the 
tropical Atlantic, and this has especially, and for the first 
time, been accomplished by my friend, Mr. Gamgee. It is 
satisfactory to have lifted Dr. Herrick so far on the fence, as 
to make him admit that yellow fever is not an endemic 
disease, " that is attributable to localized causes in any 
region whatever." As regards land, he is quite correct, and 
as regards seas, he is technically right — for remove the foul, 
and often becalmed shipping from the tropical Atlantic 
ocean, and yellow fever will be found without a habitation, 
and, for all practical purposes, not needing a name. It is 
by discussions and experiment that the strength of our posi- 
tion will be forced on the medical profession, and all we 
ask is a fair field and ample opportunity to prove our point 
or be enlightened by the correct interpretations of accumu- 



On Endernicity. 63 

lated experience, which no special pleading can now dis- 
place from the category of reliable human records. Yellow 
fever history counts some miserable exhibitions of human 
folly and prejudice, which retarded progress for years, and 
none more so than the conflict between Bancroft and Chis- 
holm, in which the latter proved triumphant. In this contro- 
versy the point was as to the actual importation of the disease 
into the West Indian Islands, and that most honest, most 
impartial and pains-taking American physician, Dr. John 
W. Francis, stated before the 1859 Convention, that " no 
fact in medical history is better established, in the whole 
range of historical testimony concerning endemics, notwith- 
standing the obloquy attempted to be cast on Chisholm by 
the late Dr. Caldwell and others, and by Bancroft, an 
equally unscrupulous writer." 

Dr. Herri ck's reference to the ship origin of the yellow 
fever in the Atlantic " as a dropsical theory of yellow fever" 
is interesting to me because, hereafter, when the question 
of priority turns up, in relation to the correct and only 
possible interpretation of the origin of yellow fever, we 
shall be able to point to the ridicule so commonly heaped 
on the promulgators of new truths and of the most im- 
portant discoveries. 

If Dr. Herrick has any facts to furnish we shall accept 
them witli as much thankfulness as I now express to Dr. 
Chaille tor his lucid arguments and convincing statistics, re- 
lating to the subject of acclimatization. The Northampton 
case I shall hereafter discuss. The weapons of philosophy 
are ascertained truths t and the purely empirical method 
pursued by many of the ablest medical observers of yellow 
fever in the past, has crushed out the theory of the land 
origin of the disease— demolished the doctrine of a specific 
animal virus, like that of small-pox, and traced epidemics 
of yellow fever to putrefaction in foul ships sailing, or that 
have sailed, on or near the Atlantic Equator. Directly or 
indirectly, this is the essential source. 



THE ORIGIN OF THE POIS03V OF YELLOW FEVER. 



Having both approved and refuted opinions and state- 
ments, hitherto made by Doctor Chaille, it is opportune that 
I should comment on that chapter, of the final report of the 
Havana Yellow Fever Commission of 1879, which has just 
made its appearance, in the October number of the New 
Orleans Medical and Surgical Journal. My greatest diffi- 
culty, in accomplishing this, is to give an adequate reflex of 
Doctor Chaille's attempt, since he has laid his case be- 
fore the medical world, without condescending to analyze 
the vast array of accumulated evidence. 

We are entirely in accord with our adversary on the re- 
sults of biological investigation. Spontaneous generation 
of organic forms, or of the specific virus of diseases propa- 
gated alone by contagion, cannot be admitted. The brief 
reference to fungi is entirely unobjectionable, except as 
bearing in any sense on the untraced lineaments of the yel- 
low fever poison. The germ theory has been made to do 
service, after it has been proved as calculated to mislead the 
world. The systematic labors of the Calcutta Sanitary 
Commission, in relation to Hallier's cholera fungus, are in 
striking contrast to the attempts of the Havana Commis- 
sion to fasten on us the u unknown." 

Pasteur's researches are justly eulogized, but none are in 
conflict with the opinion, founded on hundreds of carefully 
recorded cases, that a putrefying bilge-water, proceeding from 
a definite region and under specific conditions, emits pois- 
onous elements, destructive to human life and susceptible of 
increase outside the human body. There is one feature of 
the deadly bilge which must again be forced on public at- 



The origin of Yellow Fever Poison. 65 

tention. It is the exclusion of oxygen, and the continued 
development of foul emanations almost in proportion to 
such oxygen exclusion. Every student of biology must 
recognize that this implies some physical or chemical trans- 
formation — a death change, in the imprisoned living water 
of the equatorial Atlantic, when charging the hold with 
pestiferous miasm. Pasteur's results are incontrovertible, 
and indicate the pre-eminent mastery of natural law. They 
add to all previous demonstrations that " like reproduces 
like," but they would involve us in a confusion Avorse con- 
founded, if they implied, and they do not, that we must 
class erysipelas or purulent infection with syphilis and 
variola. 

One typical characteristic of yellow fever poison is its re- 
lation to temperature. A change of physical state is abso- 
lutely essential to its production and destruction. Being a 
tropical disease, its continuance in a semi-tropical climate 
depends on protection from climatic influences in ships, 
houses, boxes, &c. How can a poison carried anywhere on 
a pin's point be classified with one, peculiar to fomites, 
always needing encasement for distant fruition and trans- 
portation ? 

We might have expected a new and faithful picture of 
this intangible yellow fever poison, culled from Cuban ex- 
perience and genuine scientific investigation, instead of 
vague analogies, and the most superficial reference to authors 
and observers, who avowedly have seen or written on other 
diseases, knowing nothing of yellow fever. Doctor Chaille 
remarks that outbreaks of yellow fever on vessels " for 
the most part are not reported with sufficient precision 
respecting either dates or other essential details." This 
is not so ; and if so, why has he neglected those of 
the minor part ? For one case, in which there is any in- 
dication of direct dependence of an outbreak on the intra- 



66 The origin of Yellow Fever Poison. 

corporeal development of the yellow fever poison, and the 
direct transmission from the sick to the healthy, as in the 
case of scarlatina or small pox, there are thousands demon- 
strating that these exceptions are entirely illusory. There 
is absolutely no reliable evidence, on the inevitable depend- 
ence of cases of yellow fever on pre-existing cases. There 
is an overwhelming amount indicating that the emanations 
from a ship's hold have killed crews and desolated sea ports. 
Dr. Chaille has not read, or, if he has read, he has sup- 
pressed the only evidence in existence. I cannot do better 
than conclude by two letters from Mr. Gamgee's pen : 

YELLOW FEVER POISON. 

Deae De. Haegis : The battle is won. It was quite im- 
possible for Dr. Chaille to admit the land origin of yellow 
fever, and, having condemned, as erroneous, the view that 
it is the ship fever ol the Tropical Atlantic, lie was com- 
pelled to class it, as we anticipated, with the pure contagia. 
Few can be misled by his presumed analogies and pure hy- 
potheses. Those who read history will find the evidence 
of ocean origin so strong that they cannot set it aside. The 
competent medical practitioners, who know yellow fever as 
it occurs in ships and sea ports, will be unanimous in admit- 
ting, that the human body is not a necessary factor, in the 
production and transmission of the poison. Imprisoned air 
is its vehicle. When concentrated it manifests instant ef- 
fects. If weakened by dilution a supposed incubation with 
no definite limits, but always short, conforms to the action 
of ordinary poisons. 

Had our attempts, at setting fairly before the world the 
evidence and arguments in favor of the naval origin of yel 
low fever, not met with counter statements— -for of counter 
evidence there is none — it might have taken years to instil 
the truth in the public mind. Dr. Chaille has rendered the 
cause great service, and by the time we can adequately ex- 



, 



The origin of Yellow Fever Poison. 67 



pound the entire question, numerous independent students 
and reasoners will confirm our teaching. I am seeking in 
every direction for data against- us, since it is my invaria- 
ble practice to avoid, by every means at my command, any 
partial acquisition of truth which, in its blinding influence, 
is most detrimental. 

You will perceive from the annexed letter, to Kear-Ad- 
miral Daniel Ammen, United States Navy, that T have ad- 
vanced in my inquiries, as to the localization and develop- 
ment of yellow fever, before it ever acquired the precari- 
ous foothold in the West Indian and American sea ports, 
which, for over a century, has misled medical observers as 
to the home of the disease. 

If the Spanish domination of Cuba, with its incessant 
turmoils, ceased to-day, Havana would again merit Cates- 
by's eulogium. In his Natural History of Carolina, Flor- 
ida, and the Bahama Islands, published in 1743, Mark Cat- 
esby, Fellow of the Eoyal Society, says : 

" The north side of Cuba also enjoys the benefit of the 
refreshing winds, particularly that part of the island on 
which the Havana stands. To this, no doubt, is owing 
the healthiness of the air and good character of that proud 
emporium, the conquest of which, by British arms, would 
put us in possession of a country much more agreeable to 
British constitutions than any of the islands between the 
Tropics." 

I remain, dear Dr. Hargis, 

very sincerely yours, 

JOHN GAMGEE. 

Washington, October 21, 1880. 



LETTER TO REAR-ADIIRAL AIM, U. S. I., 

ON 

THE INTEK-OCEANIC SHIP CANAL 

AND THE 

YELLOW FEYEE ZONE. 



Sir : Captain De Kraft's interesting note on the respect- 
ive merits, in a nautical point of view, of the Panama and 
Nicaragua sea approaches, suggests a statement of the rela- 
tion the equatorial calms bear to yellow fever development. 

Brief reference to the res alts of historical research is es- 
sential to an understanding of the question. 

Prior to the voyage of Columbus, — and, indeed, for long- 
before his birth, the records of plagues had acquired clear- 
ness and precision. No doubt preoccupies the medical his- 
torian as to the consequences of the Crusades. The source 
and periodic invasions, in Central and Western Europe, of 
the Black Death were traced by keenest intellects. Lazza- 
retti and quarantines had been established. The origin of 
scurvy and its manifestations, in the days of Yenetian su- 
premacy, down to Yasco de Gama's voyage to Melinde in 
1498-99, have been handed down to us in interesting nar- 
ratives. Columbus crossed the ocean in shallow, small and, 
in the case of two out of three, deckless vessels. No sign, 
no trace, no word of yellow fever, till after his first voyage. 
The native West Indians had no ships and no seaports — 
ergo, they had no yellow fever. The followers of Colum- 
bus first perished from it, navigating the Atlantic calms, 
and some, perhaps many, Indians caught it in the new 
shore settlements. 

A wide stretch of the imagination has accounted for the 
depopulation of the islands by yellow fever. Ancient 
habits were crushed out by sword and torch. Fields re- 



Letter to Admiral Ammen, U. S. N. 69 

mained unsown. Famine fever spared neither hill nor 
dale. It penetrated where yellow fever, as a pestilence, 
never could prevail. Since then, the islands of the West 
Indies and likewise this continent afford no trace of yellow 
fever epidemics, except as seaports grew and sailors multi- 
plied. Voyages of discovery, Slavers from Africa plying 
their vile trade since the days of Columbus, Pirates from 
the North Seas, bore human beings to and through the 
Torrid Zone, and yellow fever became constant in ships. 
It was spoken of as " the effects of climate," flux, malignant 
fever and more specifically " calenture." The Portugese 
entitled it " morte repentina." 

The first Frenchman who visited the East Indies, Fran- 
cois Pyrard, relating his voyage of 1601, gives a graphic 
description of the dangers incurred from " injures de Fair " 
on reaching within seveu ,or eight degrees of the line and 
during the passage of the equatorial calm. The uncertain- 
ties oi navigation until the determinations of longitude, 
which practically began with Major Holmes' pendulum 
watches at sea in 1665, led to serious detentions. Dr. 
Stubbs stated, in the Philosophical Transactions for 1668, 
that " the change of climate and the effect of it are sensible 
to our bodies as we approach the tropick. There usually 
occurred, as you may observe in Purchas' voyages, sick- 
nesses in our ships about that time ; and as soon as the sea- 
men pass the tropick they still use expressions of joy by 
firing guns in testimony of gladness for their safe arrival. 
* * * * * In our ships two had the disease so 

much talked of called the calenture." 

Queen Elizabeth, whose proudest title was that of " Mis- 
tress of the Sea," granted a charter to the East India Com- 
pany in 1600. The first fleet that left lost a third or more 
of its people in the tropics. The calenture appeared as 
the}^ approached the line. It passed away as it came, with- 
out warning, when the vessels reached south of the calm 



70 Letter to Admiral Arnmen, U. S. N. 

belt of Capricorn. East Indian commerce confined yellow- 
fever, mainly, to the east of 30° W. Longitude. The ships 
left Europe sound, became infected after passing the Tropic 
of Cancer, and usually in the equatorial calms. The 
malignancy of the fever disappeared near the Cape of Good 
Hope, and scurvy commonly succeeded it in the Indian 
Ocean. This phase of plague history has remained unno- 
ticed, and my attention was specially directed to it by the 
well known outbreak of yellow fever on the Busbridge East 
Indiaman in 1792, which I felt sure could be no isolated in- 
stance, but must have conformed to a general law.* That 
the calenture of the equator was yellow fever, commonly 
affecting European traders with the East Indies, all history 
confirms. Ships returning from the Indian Ocean, China 
seas or Australia, suffered inconvenience only when reach- 
ing north of the calm belt of Capricorn, but especially 
north of 5° S. latitude. The disease disappeared north of 
the Tropic of Cancer. 

To the epidemiologist no more interesting subject pre- 
sents itself, than tracing the early beginnings, the greater 
developments, and the present decline of yellow fever. 
Where mystery and chaos reigned before, we find order 
now. 

* Alexander Stewart, surgeon to the Earl Talbot and General God- 
darcl, East Indianien, writing in 1798, said. "It is a well-known and 
melancholy truth, that these voyages when protracted beyond the 
usual length of time, from one or other reasons have hitherto been 
very generally attended with great sickness and mortality; the scurvy, 
fluxes and malignant fevers, having frequently made dreadful ravages 
amongst the crews " * * * * * * " The foul air that is gene- 
rating in the well, which is known to be of a very noxious and fatal 
nature, should be frequently purified by fire." 

"When the bilge water is much corrupted it should not be pumped 
out before breakfast, as in the morning, with an empty stomach, men 
in every situation are more liable to be affected with any noxious ef- 
fluvia." 

"It may be alleged that sickness and mortality in voyages to India 
are now less frequent than in more early times. It will be found, 
however, that this results not from a more particular attention to the 
preservation of health, but is chiefly attributed to the great improve- 
ments in navigation, which now effects a passage in a quarter or third 
of the time usual in former periods." 



Letter to Admiral Arnmen, U. S. iV 7 . 71 

Bearing in mind the statement just made, it is clear 
how French ships infected Barbadoes in 1647. In 1671 
the victorious fleet from the Panama expedition intro- 
duced the pestilential fever into Jamaica. In the year 
1690 a bloody revolution took place in the Empire of Siam. 
The French, established there, embarked for France in the 
ship Oriflamme. They were forced by stress of weather 
into Fort Boyal, Martinique, communicating a contagion 
named the " Mai de Siam," which not only assailed the 
Port, but all the vessels in the harbor. No one need be 
told to-day that Siam is beyond the yellow fever zone, nor 
that the Oriflamme succumbed to the disease in crossing the 
tropics. She affords an early instance of the practice con- 
demned by Humboldt. "In all climates," he says, "men 
imagine they find some consolation in the idea that a dis- 
ease reputed pestilential is of foreign origin. As malignant 
fevers are easily engendered amid a large crew crowded to- 
gether (entasses) in filthy vessels, the commencement of an 
epidemic dates pretty often from the arrival of a squadron." 

How slowly American sea-ports became occasional cen- 
tres of devastation I need scarcely recount. Boston, not a 
Southern city, first imported the disease, in 1693. Six years 
later Philadelphia was attacked, and in 1702 New York 
was, for the first time, invaded. Before the Eevolutionary 
War there was little commerce, and whilst the pure con- 
tagia — typically belonging to no distinct region, no alti- 
tude, no latitude nor longitude, such as small-pox — ravaged 
the country, the so-called West Indian fever had but slen- 
der chance for more than very limited introduction in the 
cities of the shore, and never reached inland. The Eevo- 
lutionary War effectually excluded it. The Siam fever 
was forgotten, but ports in Spain and France were contam- 
inated, owing to their trade with the West Indies. These 
were, however, free at intervals, until a new era was 
reached, when the ship Hankey, necessarily crossing the line, 



72 



Letter to Admiral Ammen, U. S. N. 



arrived from Bulam, early in the year 1793, and started 
the most virulent plague epoch which ever assailed this 
country. The massacre of San Domingo added to all its 
horrors the cruel slaughter, by yellow fever, of the hospi- 
table succorers of the Creole refugees, who were fortunate 
enough to reach American ports alive. 

The College of Physicians of Philadelphia, whose 1797 
Memorial, to the Senate and House of Eepresentatives of 
the Commonwealth of Pennsylvania, saved the honor 
of medicine at this period, effectually disposed of the 
opinions of Eush, Caldwell, and other professional advo- 
cates of the indigenous origin of the disease. That memo- 
rial rebutted the monstrous proposition that yellow fever 
was a plague of the American Continent. It traced it "to 
the infected clothing of persons who died in the West In- 
dies. In most of the cases where the infection cannot be 
ascertained, the first appearance of the disease has been, as 
in the other instances, in the neighborhood of the shipping, 
or among persons connected with vessels." . . "In most of the 
instances of the occurrence of the disease in the United 
States, there has been war in the West Indies." Eeferring 
to these wars, Burke said : " In these adventures, it is not 
an enemy we have to vanquish, but a cemetery to acquire." 
Our gallant British troops, destined to encounter barba- 
rians, and "most of them in the bloom of youth, were con- 
veyed," says Bryan Edwards, " with little intermission, from 
the ship to the hospital, from the hospital to the grave!" 
Where every advantage was "but a new demand for recruits 
to the West Indian" tombs, entire regiments being exter- 
minated, how could America escape the hideous consequences 
of unwholesome intercourse? 

Napoleon repeated the deluge ol human blood, sacrificed 
to yellow fever, by his memorable West Indian expedition 
in 1805. The contest raging in Europe, and the Berlin de- 
cree of 1806 blockading the British Islands, interrupted the 



Letter to Admiral Ammen, U. S. N. 73 

profit America was deriving from the destruction of the 
ships and commerce of other nations. The President rec- 
ommended to Congress that the seamen, ships, and mer- 
chandise of the United States be detained in Port. The 
embargo was established, and until its removal by Madison 
on his accession to power in 1809, ocean commerce and 
yellow fever were alike extinguished. The plague returned 
in 1811, but the war of 1812-14 again closed the Atlantic 
sea-ports, and complete immunity reigned till commerce 
began to revive in 1817. A new factor soon came into op- 
eration in the shape of emigration to the Southern States, 
and imperfect quarantine admitted the disease annually, 
not only into the ocean harbors, but up the rivers acces- 
sible to the West Indian ships. The most active cause of 
virulent outbreaks in the Islands was the active, irregular, 
and barbarous traffic in slaves. 

The events of the late rebellion, sustaining previous his- 
tory, are too fresh in the people's minds to need exposition 
here. I need not unduly extend this cursory glance at the 
invasions of the only genuine ocean pestilence on the Globe. 
The Equatorial calm belt continued the centre of uncertain 
and usually prolonged detentions. Steamships then opened 
a new era of yellow fever decline, and American hydrogra- 
phers contributed most, by their records and charts, to re- 
duce the passage of sailing ships from the North to the 
South Seas. To the latter circumstance must we ascribe 
the comparitive immunity enjoyed by Australian clippers, 
which have, however, at times encountered the ship fever of 
the tropical Atlantic — often escaping with less mor- 
tality than the old East Indiamen. Had the medical 
profession of New Orleans followed their great teacher, 
Carpenter, they might long since have seen that whilst the 
Mexican Gulf, like all other almost land locked seas, is free 
from transmissible ship-fever, the annual and, frequently, 
disastrous importations of the disease by vessels from Eu- 



74 Letter to Admiral Ammen, U. S. N. 

rope, was due to the tedious course compelling detention in 
the calm belts. The passage through the Caribbean Sea 
is the occasion of its manifestation, and on the north- 
ward progress to New Orleans the disease acquires epidemic 
proportions. On leaving the Gulf for Europe a vessel at once 
enters the Gulf Stream and the trades, and is soon blown 
beyond harm's reach. Its purification, on the speedier east- 
ward voyage, is due to similar influences to those which 
operate South of Capricorn in ships bound for the Indian 
Ocean. 

To conclude : — the hottest open sea in the World, the 
western half of the Equatorial Atlantic, is the constant cen- 
tre of yellow fever development in becalmed ships. The 
eastern half once was, owing to the peculiar conditions of 
British East India commerce, the perennial seat of malig- 
nant naval outbreaks, always commencing and ending in mid - 
ocean. The opening of the proposed Panama Canal, level 
with the sea, in the very midst of the Equatorial Calms 
would, in my opinion, have the following effects, until sail- 
ing ships and wooden vessels, liable to decay and contami- 
nation, are abolished. 

In the first place, the long voyage from Europe would 
often result in sickness by the time a vessel reached the ex- 
treme west of the tropical Atlantic. Slow towage through 
the canal would not help it. Its abandonment to six hundred 
miles of shifting winds and calms in the Pacific would 
seriously aggravate its ills, and might tend to unprecedented 
extensions of the disease in that Ocean. 

Secondly. The peculiar properties of Ocean water with its 
teaming forms of life, which undoubtedly account for the 
poisonous bilge^emanations of vessels in the equatorial At- 
lantic, would invade the canal water and probably extend 
into the Pacific. An argument against this theory, how- 
ever, may be that the colder waters of the Pacific might op- 
pose this westward current. It must not be forgotten that 



Letter to Admiral Ammen, U. S. N. 75 

the strip of land between the oceans effectually separates 
their waters, fauna and flora. Antartic ice maintains the 
high average salubrity and immunity from yellow-fever of 
the equatorial Pacific, in contrast to the opposite conditions 
in the equatorial Atlantic. 

Thirdly. Vessels reaching the mouth of the Nicaragua 
Canal more speedily, and blown across the fresh water lake 
by the constant breezes which disturb it, would be placed 
in the best possible sanitary state, by free ventilation as in 
the OcQan trade winds and by washing out of any putrescent 
ocean residue. They would pass into the north Pacific 
current free from the dangers incurred in and beyond Pan- 
ama Baj^. 

I have not entered on the dangerous land fever which 
assailed the laborers on the Panama Railroad, since my field 
of inquiry has been more especially in relation to that 
equatorial plague, which has been limited in its Pacific ex- 
tensions by the purifying influences of wind and cold, in the 
passage round the Horn. 

The localization of } r ellow fever and the limitations by 
natural conditions, so universally observed during the past 
four centuries, point to the facility with which this conti- 
nent may be permanently and unfailingly protected from 
that disease. All ships from the yellow fever zone, rather 
than those only from infected ports, should, during the 
"dangerous months, be purified before contact with land. 
This demands machinery and disciplined crews afloat, ade- 
quate to ship purification in any latitude. 

Contact with quarantine grounds leads to outbreaks, 
such as have caused dangerous medical dissensions in 
the recent outbreak on the Mississippi. Medical disputants 
continue their doctrinal defences, whilst the Mississippi 
Valley lies exposed to the utmost danger. Frost ends the 
discussion by disappearance of the disease. There is but 
one method whereby this country can be permanently pro- 
tected from the scourge. Cold is its only known and 



76 Letter to Admiral Amme7i, U. S. N. 

available antidote. Fumigations and fetid disinfectants 
have all signally failed. The construction of the Kefrigera- 
ting Ship, approved by Congress, would afford a demonstra- 
tion surpassing in importance all else attempted in relation 
to yellow fever prevention. 

Addressing these words to an Admiral of the United 
States Navy, I feel confident they will not be deemed out 
of place. 

I remain, Sir, with much respect, 

Your obedient servant, 

JOHN GAMGEE. 

Kiggs House, "Washington, D. C, 

October 18, 1880 



I35TDE3:. 



Acclimatization 28, 54 

" in the Mediterranean against yellow fever 7 

Air the best purifier 5 

Alison, Dr., origin of yellow fever in ships 33 

American Continent not the home of yellow fever 72 

Ammen, Letter to, by Prof. Gamgee 68 

Anne Marie infected 47 

Ascertained truths the weapons of philosophy 63 

Audouard, Dr., origin of yellow fever on ships 33 

Ball's, Dr., conclusions 41 

Barcelona epidemic 27 

Black Death 68 

Blair, Dr. Daniel, on yellow fever 58 

Boston epidemic 71 

Breeze favors and sometimes hinders spread 50, 75 

Brown, Dr. Harvey E., on depopulation 5 

Burgess, Dr., on yellow fever in ships 38 

Burke on Wars in the West Indies 72 

Busbridge East Indiaman 70 

Calenture 69 

Caldwell, Dr. Chas., on yellow fever 20, 60 

Calm belts unhealthy 45 

Caneda, Dr. de, on yellow fever 37 

Carpenter, Dr., on yellow fever 73 

Carribbean Sea, yellow fever in 42 

Cemetery of Espada 29 

Chaille, Dr., on acclimatization 54, 57 

" " evidence in opposition to nautical origin 34, 38 

" " letters to Pensacola Advance 11, 16 

Charter, E. India Company's 69 

Chaumont, Dr. de, 4 

Children with yellow fever 57 

Chisholm, Dr., conflict with Bancroft 63 

Circlair 53 

Columbus 3, 68 

Copland origin in ships 4, 33 

Coup de Barre 27 

Course of ships on the Atlantic 47 

Crews of ships often protected 28 

Cuba, naturally healthy. . . . 27, 67 

Cubans suffer from yellow fever 54 

Dickson, Dr., origin of yellow fever in ships 33 

Domestic origin of yellow fever, Dr. Caldwell on 20, 72 

" Dr. Drake on 26 

" Dr. Emlenon 59 

" Dr. Herrick on 59 



II 

t 

Domestic origin of Yellow Fever, Dr. Hutchinson on 59 

" Dr. Lawson on 60 

" " Dr. Rush on 59 

Drake, Dr. Daniel, on yellow fever 59 

Dropsical theory of yellow T fever 63 

Dunglison, Dr., on endemic 22 

Dutroulau, Dr. . A F., on yellow fever in ships 15, 36 

Edwards, Bryan, on West India Fever 72 

' ' Eliza ' ' infected from Leghorn 40 

Elizabeth, Queen, mistress of the sea 69 

Embargo from 1806 to 1809 72 

Emlen, Dr. Samuel, on yellow fever 59 

Endemics, Dr. Aitkin's (definition 25 

" Dr. Dunglison's definition 25 

Dr. Hobfyn's " 24 

" Dr. Roger Tracy's definition 25 

Dr. C. B. Williams' definition 24 

Endemicity, Dr. Herrick on 59 

Dr. Tully on 22 

" of yellow lever and small-pox 40 

" of yellow fever in Cuba 19 

Epidemics of yellow fever continued by removing the sick. . . 7 

Faget, Dr. J. C, on ship origin 33 

"Fair wind " a fever carrier 46 

Fatal endemic on the Escambia in 1776 28 

Feraud, Dr. Berenger, on yellow fever. .......... 36 

Ferguson, Dr., on ship origin 33 

Fever carrying ships 46 

" producing ships 45 

Fort Jeflerson, yellow fever 6 

Foul ships with yellow fever , 4 

Francis, Dr., on Chisholm 63 

" " on yellow fever 60 

French authorities on yellow fever 37 

Fuzier, Dr., on yellow fever 36 

Gamgee, John, on yellow fever in the calm belts 2, 7, 10, 33 

" " on the circlair 53 

" " on course of ships from Europe . . . . 47 

" " on currents of pure air 51 

" " on refrigeration 75 

" "on seas exempt , 7 

" " on ships fever — proof 52 

" " work on j^ellow fever a nautical disease 3,7 

" on the British East Indiaman 69 

" " Inter-Oceanic Canal and yellow fever 67 

" ' on Oroya fever 7 

letter to Dr. Hargis 66 

"" " letter to Admiral Ammen , 68 

Gama's, Vasco de, voyage , 68 

Germ theory of yellow fever without basis in fact 34 

Governor's Island, yellow fever on 6 

Griesinger, Dr., definition of yellow fever 60 

Griffiths, Dr. on ship fever , 32 

Hankey, yellow feVer in 71 

Havana not incurably infected 39, 67 

" sanistation for. 52 



in 

Heineuiann, Dr., on Vera Cruz 54 

Herrick, Dr., statement 61 

' ' " refutation of 61 

Holmes' pendulum watches 69 

Hosack, Dr. David, views on yellow fever . . 32 

Huguenots on the Escambia 44 

Humboldt on ship fever 71 

Immunity of Pensacola in 1878 43 

Incubation, period of 47 

Indianola, yellow fever in 5 

Introduction 3 

Kraft, Captain de, on calms 68 

Land infected vessels 46 

La Roche on ship origin 32, 40 

Lawson, Dr. Thomas, on yellow fever 60 

Le Bceuf, infected 27 

Le Hardy, Dr. J. C, on the National Board of Health 10 

Lime, burnt, as a disinfectant 52 

Lind, Dr., diseases of hot climates 28 

" " on Escambia malaria 44 

" " on removal of sick to ships 37 

Loggerhead, yellow fever at 6 

London, General Board of Health 62 

Mai de Siara I 71 

Marseilles, ship from, infected 32 

" Mary, " sloop, report on 32 

Massacre of St. Domingo 72 

Medical profession in New Orleans believed Creoles exempt... 55 

Memorial of Philadelphia, Col. of Phys 72 

Memphis depopulated, bat not clear ot yellow fever till frost.. 50 

Milton, refugee, with sudden attack 49 

Mortality amongst children 57 

National Board of Health 9 

Naval surgeons on yellow fever 35 

New Orleans, medical men on 59, 73 

Nitrous acid fumes objectionable 4 

Noah Webster, a catastrophic etiologist 8 

Northampton infected in 1853 31, 42 

Operations of the National Board of Health 9 

Oriflamme 71 

Oroya fever 7 

Parkes, Dr., practical hygiene , 41 

" on origin of yellow fever 4 

Penrose, Dr. Thomas N., on Ticonderoga outbreak 39 

Pensacola, Florida, healthy 11 

exempt in 1878 42 

" quarantine successful at 49 

Pyrard's voyage 69 

Rats and roaches dead in bilge 45 

Rebellion stopt yellow fever 73 

Refrigeration a sure antidote 52 

Rio infected ships 46 

Rotten ships, ocean infected 45 

Rush, Dr., on yellow fever 20, 32, 60 

Saint Nazaire outbreak 47 

Sanistation, a substitute for quarantine 10 

' ' for Havana 52 



IV 



Sea shore, yellow fever traced to the 59 

Ship fever of the tropical Atlantic 66 

Ships infected 9, 60 



Dr. Griffiths on. 

Snip poison concentrated 

Small-pox endemic in Cuba 

Source of disease , 

Stewart, Alexander, on sickness in East Indiamen. 

Stone Warren, Prof., on domestic origin 

' ' " on yellow fever in Creoles 

Stranger oiding places where natives enjoy immunity, 

Stubbs. Dr., on calenture 

Tully, Dr. endemicity 

Quarantine an Sanitary Convention , 

" sue - Hful at Pensacola 

Vera Cruz epidemics 

Water ballast safest 

War of 1812 stopped yellow fever 

West India not depopu ated by yellow fever. 
Yellow fe 



32 
44 
24 
41 
70 
31 
55 
56 
69 
22 
60 
49 
55 
45 
73 
68 
3,7 
33 
33 
4,33 



ver a nautical disease, by Prof. John Gamgee 

Alison, Dr. , on 

Audouard, Dr., on 

Copland, Dr., on 

Dickson, Dr., on 

Emlen, Dr., on 33 

Stone, Dr. , on 55 

endemic in Cuba 12, 27 

its place in nature 62 

in ship from Marseilles 32, 40 

31 

47 

40 

6 

6 

5 

6 

6 

6 

..... 44 

35 

23 

53 

42 

47 

48 

39 

68 



in ship Northampton. 

" Anne Marie 

" Eliza 

in Fort Jefferson in 1873 

" Governor's Island in 1870 

" Indianola in 1867 

" Loggerhead 

" permanent barracks 

" infected hold of ship 

malignant in clean and unclean places. 

naval surgeons on 

poison from outside the human body. . , 

poison surely destroyed 

prevention 

period of incubation not definite 

sometimes instantaneous 

tendency to disappear 

zone 



